Economic Evaluation of a Pharmacogenomics Test for Statin-Induced Myopathy in Cardiovascular High-Risk Patients Initiating a Statin

Mitchell, Dominic; Guertin, Jason R.; Iliza, Ange Christelle; Fanton-Aita, Fiorella; LeLorier, Jacques

doi:10.1007/s40291-016-0238-8

Cited by 17 publications

(12 citation statements)

References 22 publications

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“…This was addressed by a study that examined the economic feasibility of a theoretical pharmacogenomic test for SI secondary to myopathy in high-risk populations, compared to the alternative of statin discontinuation. This study found that the use of a pharmacogenomic test is a beneficial strategy for any test costing less than CAN$356 (Canadian dollars) [35]. This was further supported by another study that found that in highrisk populations, using pharmacogenomic testing is also cost-effective to maintain patients on a statin given the cardiovascular benefit, despite possible risk of rhabdomyolysis [36].…”

Section: The Somatosensory Amplification Scale (Sas)mentioning

confidence: 60%

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Singh¹,

Sirna²,

Dajani³

et al. 2019

Cardiovasc Disord Med

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Background: Lipid management with statins is one of the mainstays of treatment for atherosclerotic cardiovascular disease. Statins are often discontinued by patients secondary to muscle-related complaints independent of elevations in creatine kinase. It has also been suggested that there is a link between mental health disorders and noncompliance. The associations between negative affect and somatization reported as medication-related side effects requires further clarification. One possible cause of statin discontinuation is perceived myopathy secondary to somatization.Objective: This study examines the relationship between affect in statin tolerant and statin intolerant (SI) groups.Methods: This study incorporated patients unable to tolerate at least two different statins (any statin or dosage prescribed) due to side effects or abnormal laboratory markers. Patients completed The Depression Anxiety Stress Scales, the McGill Pain Questionnaire, and the Somatosensory Amplification Scale.Results: There were 20 statin tolerant (ST) patients and 13 SI patients (n=36). There was a significant difference between SI and ST groups, respectively, in age (63 vs. 70 years, p=0.04), total cholesterol (204 vs.136, p <0.01), and LDL cholesterol (129 vs. 136, p < 0.05). There were no significant differences between ST and SI groups for somatic pain, affective pain, somatosensory amplification, depressive symptoms, anxiety symptoms, and stress scores. Conclusion:Our study suggests the discrepancy between statin intolerance in clinical trials and clinical practice cannot be explained solely by somatosensory amplification, anxiety, depression or pain disorders. Nevertheless, an affective and/or anxiety disorder will likely augment the pain perception and somatization in a SI patient.

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Section: The Somatosensory Amplification Scale (Sas)mentioning

confidence: 60%

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Singh¹,

Sirna²,

Dajani³

et al. 2019

Cardiovasc Disord Med

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“…30 QALY utility weights from the literature were assigned to health states indicating CAD, 31 stroke, 31 and statin side effects. 31,32 Utility weights for high-risk individuals without CAD, stroke, or statin side effects accounted for utility decrement associated with age. 33…”

Section: Model Parametersmentioning

confidence: 99%

Integrating a Polygenic Risk Score for Coronary Artery Disease as a Risk Enhancing Factor in the Pooled Cohort Equation is Cost-effective in a US Health System

Mujwara¹,

Henno

et al. 2021

Preprint

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ImportanceThe pooled cohort equation (PCE) is used to determine an individual’s 10-year risk (low, borderline, intermediate, or high) of atherosclerotic cardiovascular disease (ASCVD) but it fails to identify all individuals at high risk. Those with borderline or intermediate risk require additional risk enhancing factors to guide preventive therapy decisions. Including a polygenic risk score (PRS) for coronary artery disease as a risk enhancing factor improves precision in determining the risk of ASCVD and informs decisions for prevention therapy.ObjectiveTo assess the cost-effectiveness of integrating PRS for coronary artery disease with the PCE to determine an individual’s 10-year risk for ASCVD compared to the PCE-alone.Design, setting, and populationA Markov model was developed on a hypothetical cohort of 40-year-old individuals in the US with borderline or intermediate PCE 10-year risk for ASCVD who fall in the top quintile of the PRS distribution and are not on preventive therapy (e.g., statins). Model transition probabilities and economic costs came from existing literature with costs reflecting a payer perspective and inflation-adjusted to 2019 US$.InterventionsThe modeled strategies were: (1) the PCE-alone and (2) the PCE with PRS for coronary artery disease as a risk enhancing factor. Analyses were performed at 5 year, 10 year, and lifetime time horizons.Main outcomes and measuresQuality-adjusted life-years (QALYs) gained, acute coronary syndromes and ischemic stroke events prevented, mean costs, and incremental cost-effectiveness ratios (ICER) were measured. One-way, two-way, and probabilistic sensitivity analyses were used to assess uncertainty in parameter estimates. Future costs and health benefits were discounted at an annual rate of 3%.ResultsCompared to the PCE-alone, PCE+PRS was cost-saving, effective and cost-effective (dominant). A health system would save more than $500, $2,300, and $9,000 per additional high-risk individual identified using PCE+PRS and prevent 27, 47 and 83 acute CAD or ischemic stroke events per 1,000 persons in 5 year, 10 year, and lifetime time horizons, respectively.Conclusions and relevanceImplementing PRS as a risk enhancing factor for CAD among individuals with borderline or intermediate 10-year risk reclassifies individuals as high-risk who would otherwise remain unidentified, prevents future acute CAD and ischemic stroke events, and both saves money and is cost-effective for health systems.Key PointsQuestionIs it cost-effective to use polygenic risk scores (PRS) for coronary artery disease (CAD) among individuals with borderline or intermediate risk of atherosclerotic cardiovascular disease (ASCVD) to inform preventive therapy decisions?FindingsWe modeled a hypothetical cohort of individuals with borderline or intermediate risk of ASCVD who fall in the top quintile of the CAD-PRS distribution but not on preventive therapy. Integrating CAD-PRS in the pooled cohort equation improved quality-adjusted life-years, saved money and was cost-effective.MeaningIntegrating PRS as an enhancing factor in the pooled cohort equation risk assessment for ASCVD used in current clinical practice was cost-effective.

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“…The pharmacogenomic properties of statins may guide to a personalized medicines with fewer risks and more efficiency. [4][5][6] RIGHT TIME…”

Section: Right Patientmentioning

confidence: 99%

A better treatment for saphenous vein graft disease after coronary artery bypass surgery: Might statins be the answer at the right dose to the right patient at the right time?

Bianchi

Petrucci

2019

The Journal of Thoracic and Cardiovascular Surgery

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Economic Evaluation of a Pharmacogenomics Test for Statin-Induced Myopathy in Cardiovascular High-Risk Patients Initiating a Statin

Cited by 17 publications

References 22 publications

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Somatosensory amplification, depression, anxiety and pain in statin intolerant patients

Integrating a Polygenic Risk Score for Coronary Artery Disease as a Risk Enhancing Factor in the Pooled Cohort Equation is Cost-effective in a US Health System

A better treatment for saphenous vein graft disease after coronary artery bypass surgery: Might statins be the answer at the right dose to the right patient at the right time?

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