Cost-effectiveness analysis of pharmacogenomics-guided clopidogrel treatment in Spanish patients undergoing percutaneous coronary intervention

Fragoulakis, V.; Bartsakoulia, Marina; Díaz-Villamarín, Xando; Chalikiopoulou, Constantina; Kehagia, K.; Ramos, Jesús Gabriel Sánchez; Martínez-González, Luis Javier; Gkotsi, Maria; Katrali, E; Skoufas, Efthimios; Vozikis, Athanassios; John, Anne; Ali, Bassam R.; Wordsworth, Sarah; Dávila-Fajardo, Cristina Lucía; Κάτσιλα, Θεοδώρα; Patrinos, George P.; Mitropoulou, Christina

doi:10.1038/s41397-019-0069-1

Cited by 22 publications

(19 citation statements)

References 20 publications

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“…One of the stakeholders disclosed that they are in the process of studying this in UAE and got the green light from the institutional review board to do so. This demeanor leverages the implementation of genomic medicine and pharmacogenomics in UAE as numerous researches provided evidence pertaining to the cost-effectiveness of genomic medicine and pharmacogenomics [47-51].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Stakeholders’ Interest and Attitudes toward Genomic Medicine and Pharmacogenomics Implementation in the United Arab Emirates: A Qualitative Study

Rahma

Elbarazi

Ali

et al. 2021

Public Health Genomics

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Background and Aim: Mapping the power, interest, and stance of stakeholders is a cornerstone for genomic medicine implementation. In this study, we aimed at mapping the power/interest of various stakeholders in United Arab Emirates (UAE) and exploring their attitudes toward pressing health genomics aspects. The overarching aim of this study is to facilitate the construction of a road map for the full implementation of genomic medicine and pharmacogenomics in the UAE with potential applicability to many healthcare systems around the world. Methods: A qualitative approach using in-depth interview was employed. Heterogeneous stakeholders were identified by experts in the field. The analysis of the data was a hybrid of deductive and inductive approach using NVivo software for coding and analysis. Results: 13 interviews were conducted. Following mapping the Mendelow’s matrix, we categorized the stakeholders in UAE to promoter, latent, defender, and apathetic. Most of the interviewed stakeholders emphasized the clinical demand for genomic medicine in UAE. However, many of them were less inclined to articulate the need for pharmacogenomics at the moment. The majority of stakeholders in UAE were in favor of building infrastructure for better genetic services in the country. Stakeholder from an insurance sector had contradicting stance about the cost-effectiveness of genomic medicine; the majority were concerned with the legal and ethical aspects of genomic medicine and had an opposing stance on direct-to-consumer kits. Conclusions: Implementing the Mendelow’s model will allow the systematic strategy for implementing genomic medicine in UAE. This can be achieved by engaging the key players (promoters and defenders) as well as engaging and satisfying the latent stakeholder.

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Section: Discussion/conclusionmentioning

confidence: 99%

Stakeholders’ Interest and Attitudes toward Genomic Medicine and Pharmacogenomics Implementation in the United Arab Emirates: A Qualitative Study

Rahma

Elbarazi

Ali

et al. 2021

Public Health Genomics

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“…There are different cost-effectiveness studies supporting that preventive genotyping test of CYP2C19 is cost-effective and could be applicable in clinical practice [60,61,62,63]. In collaboration with The Golden Helix Foundation, in 2018 we performed a cost-effectiveness analysis of pharmacogenomic-guided antiplatelet treatment using the data published [60] by our team regarding Spanish ACS patients who underwent PCI [35]. This study is one of the very few that aims to compare the cost-effectiveness of antiplatelet treatment modalities retrospectively versus prospectively genotyped patients for the CYP2C19 *2, CYP2C19 *3, and CYP2C19 *17 alleles.…”

Section: The Most Relevant Evidence In Pharmacogenetics Of Drugs Umentioning

confidence: 99%

Pharmacogenetics in the Treatment of Cardiovascular Diseases and Its Current Progress Regarding Implementation in the Clinical Routine

Dávila-Fajardo

Díaz-Villamarín

Antúnez-Rodríguez

et al. 2019

Genes

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There is a special interest in the implementation of pharmacogenetics in clinical practice, although there are some barriers that are preventing this integration. A large part of these pharmacogenetic tests are focused on drugs used in oncology and psychiatry fields and for antiviral drugs. However, the scientific evidence is also high for other drugs used in other medical areas, for example, in cardiology. In this article, we discuss the evidence and guidelines currently available on pharmacogenetics for clopidogrel, warfarin, acenocoumarol, and simvastatin and its implementation in daily clinical practice.

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“…Clinical studies of genotype-guided clopidogrel therapy have demonstrated cost-effectiveness, non-inferiority, and improved safety compared to other oral P2Y 12 antagonists. [3][4][5] Previously, some healthcare systems implemented genetic testing of CYP2C19 6,7 to predict the clinical effectiveness of clopidogrel in their patients. 7,8 However, genetic variation is only one contributor to therapeutic outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Genetic testing is beginning to be used to assess the clinical effectiveness of clopidogrel. Clinical studies of genotype‐guided clopidogrel therapy have demonstrated cost‐effectiveness, noninferiority, and improved safety compared to other oral P2Y 12 antagonists 3–5 . Previously, some healthcare systems implemented genetic testing of CYP2C19 6,7 to predict the clinical effectiveness of clopidogrel in their patients 7,8 .…”

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confidence: 99%

Risk Factors for Bleeding and Clinical Ineffectiveness Associated With Clopidogrel Therapy: A Comprehensive Meta‐Analysis

Nguyen

Eadon

Yoo

et al. 2020

Clinical Translational Sci

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Although clopidogrel is a frequently used antiplatelet medication to treat and prevent atherothrombotic disease, clinicians must balance its clinical effectiveness with the potential side effect of bleeding. However, many previous studies have evaluated beneficial and adverse factors separately. The objective of our study was to perform a comprehensive meta‐analysis of studies of clopidogrel’s clinical effectiveness and/or risk of bleeding in order to identify and assess all reported risk factors, thus helping clinicians to balance patient safety with drug efficacy. We analyzed randomized controlled trials (RCTs) of maintenance use in four stages: search for relevant primary articles; abstract and full article screening; quality assessment and data extraction; and synthesis and data analysis. Screening of 7,109 articles yielded 52 RCTs that met the inclusion criteria. Twenty‐seven risk factors were identified. “Definite risk factors” were defined as those with aggregated odds ratios (ORs) > 1 and confidence intervals (CIs) > 1 if analyzed in more than one study. Definite risk factors for major bleeding were concomitant aspirin use (OR 2.83, 95% CI 2.04–3.94) and long duration of clopidogrel therapy (> 6 months) (OR 1.74, 95% CI 1.21–2.50). Dual antiplatelet therapy, extended clopidogrel therapy, and high maintenance dose (150 mg/day) of clopidogrel were definite risk factors for any bleeding. Reduced renal function, both mild and severe, was the only definite risk factor for clinical ineffectiveness. These findings can help clinicians predict the risks and effectiveness of clopidogrel use for their patients and be used in clinical decision support tools.

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Cost-effectiveness analysis of pharmacogenomics-guided clopidogrel treatment in Spanish patients undergoing percutaneous coronary intervention

Cited by 22 publications

References 20 publications

Stakeholders’ Interest and Attitudes toward Genomic Medicine and Pharmacogenomics Implementation in the United Arab Emirates: A Qualitative Study

Stakeholders’ Interest and Attitudes toward Genomic Medicine and Pharmacogenomics Implementation in the United Arab Emirates: A Qualitative Study

Pharmacogenetics in the Treatment of Cardiovascular Diseases and Its Current Progress Regarding Implementation in the Clinical Routine

Risk Factors for Bleeding and Clinical Ineffectiveness Associated With Clopidogrel Therapy: A Comprehensive Meta‐Analysis

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