Dissertation (Doctoral) A Cost-effectiveness Analysis of Maternal Genotying to Guide Treatment for Postpartum Pain and Avert Infant Adverse Events


Myla Emily Moretti


BACKGROUND: The maternal and infant benefits of breastfeeding are numerous, however maternal exposure to medications during lactation raises concerns of infant exposure and may be an impediment to breastfeeding. Recent concerns about the safety of codeine, an analgesic commonly used after delivery, have arisen. Evidence suggests that mothers with an ultrarapid metabolizer phenotype may put their infants at risk for adverse events by producing more active metabolite, which is excreted into milk. Pharmacogenetic screening may be a valuable tool to identify such mothers, and avert adverse events.

OBJECTIVES: The objective of the study was to determine the incremental costs of genotyping to averting neonatal adverse events during maternal pharmacotherapy.

METHODS: A cost effectiveness analysis to determine the incremental costs of genotyping to guide codeine therapy compared to standard care to avert adverse events was performed. The base case was a prenatal patient whose metabolizer status was unknown, but who may require codeine analgesia after delivery. Parameter estimates and costs were ascertained from a concurrent clinical study, from the literature and expert opinion.

RESULTS: Pharmacogenetic screening resulted in a cost of $9,997.43 per adverse event averted or $2,173.35 per infant symptom day averted, when compared to standard care. The results were not sensitive to most variables in one way analysis, with the exception of the costs of a hospital admission. This study was limited by a small number of trials from which parameter estimates could be extracted and the very small number of adverse events reported in infants in the literature.

CONCLUSIONS: Although genotyping to guide pharmacotherapy was not cost saving, the cost to avert an infant adverse event may represent good value for money. It is not yet known whether implementation would be clinically viable, however these findings will have implications for new mothers and their health care providers world-wide.


Wendy J. Ungar


Howard Berger