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Objectives: The decision of antiplatelet therapy after a percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) patients is complicated. Clopidogrel requires activation by cytochrome P450 (CYP), primarily CYP2C19. Patients with CYP2C19 loss-of-function alleles are at increased risk of major adverse cardiovascular events. Ticagrelor is a more effective and expensive alternative antiplatelet agent that is unaffected by the CYP2C19 polymorphism. Genotype-guided therapy is used to determine the CYP2C19 mutation carrier's status so that the more expensive ticagrelor can be selectively prescribed to patients with loss-of-function alleles. The study aimed to evaluate the cost-effectiveness of CYP2C19*2/*3 genotype-guided antiplatelet therapy compared to the universal use of ticagrelor or clopidogrel in ACS patients who undergo PCI. Methods: A two-parts model, including a one-year decision-analytic model and a 20-years follow-up Markov model, was created from the Qatar health-care provider's perspective, to follow the use of (i) universal clopidogrel, (ii) universal ticagrelor, and (iii) genotypeguided antiplatelet therapy. Outcome measures were the incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICER) of genotype-guided therapy. Therapy success was defined as survival without myocardial infarction, stroke, stent thrombosis, cardiovascular death, or the no therapy discontinuation due to adverse events. The base-case modeling was based on a multivariate analysis of uncertainty in probabilistic and utility input data. Results: Base-case 1-year results illustrated that CYP2C19 genotype-guided therapy was cost-effective compared to the universal use of clopidogrel and ticagrelor (ICER of US$ 3,836 and 4,964, respectively, per one case of success without ADR). While the universal use of clopidogrel was dominant over the universal use of ticagrelor. Over the long-term Markov model, genotype-guided therapy was dominant compared to both universal ticagrelor and clopidogrel. Conclusions: The CYP2C19 genotype-guided antiplatelet therapy appears to be the preferred antiplatelet strategy over the universal use of ticagrelor or clopidogrel for ACS patients undergoing PCI in Qatar.

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4.89; I 2 =0%; 2 studies), complications (RR=0.37; 95%CI: 0.21, 0.65; I 2 = 0%; 2 studies), blood loss (mean difference= -1634.9ml; 95% CI: -2242.2ml, -1027.5ml; I 2 = 0%; 3 studies), and visual analogue scale (mean difference= -0.78; 95% CI: -1.50, -0.03; I 2 = 0%; 3 studies). Infection risk (RR=0.40; 95%CI: 0.09, 1.69; I 2 =0%; 2 studies), favorable change in cobb angle (mean difference= -0.38; 95% CI: -3.19, 2.43; I 2 =90.6%; 3 studies), and Oswestry Disability Index (mean difference= -3.45; 95% CI: -8.35, 1.45; I 2 =0%; 3 studies) were not significantly different between surgery types. Conclusions: Following a comprehensive pooling of the literature, this meta-analysis demonstrated that MIS was associated with better health and safety outcomes in adult patients with adult degenerative scoliosis compared to OS. Further studies are needed to allow for subgroup analyses and identification of specific patient populations who may benefit the most from MIS vs OS.

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