Short- and long-term cost-effectiveness analysis of CYP2C19 genotype-guided therapy, universal clopidogrel, versus universal ticagrelor in post-percutaneous coronary intervention patients in Qatar

AlMukdad, Sawsan; Elewa, Hazem; Arafa, Salaheddin; Al‐Badriyeh, Daoud

doi:10.1016/j.ijcard.2021.01.044

Cited by 9 publications

(9 citation statements)

References 44 publications

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“…Two studies focused on the medical economics of treatment strategies based on cardiac genetics (FH), whereas the others concentrated on the cost-effectiveness of drug selection (GGT) based on the CYP2C19 LOF allele. I finalized nineteen reports related to antiplatelet therapy after PCI and two reports (treated as references) on genetic screening for FH [6,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. Post-PCI antiplatelet therapy (including GGT) articles consisted of two review papers, one RCT (application to simulation study), two cohort studies, and 14 simulation (model calculation) reports (Table 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

Consideration of the Medical Economics of Cardiac Genetics, Focusing on the Cost-Effectiveness of P2Y12 Inhibitor Selection Based on the CYP2C19 Loss-of-Function Allele: A Semi-Systematic Review

Takura

2024

Cardiogenetics

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Medical economics is essential in cardiac genetics for the clinical application and development of research results. However, related economic evaluations are unclear, and limited systematic reviews are available on the cost-effectiveness of drug selection based on the CYP2C19 LOF allele. This review analyzed research in the MEDLINE database from January 2012 to June 2023 using more evidence than a well-designed cohort study, owing to the lack of relevant research in the database. For example, cost-effectiveness analyses are often reported as simulation assays, and were included in this analysis. No conditions related to patient background or antiplatelet drug therapy were selected. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (2020). Twenty-one cardiac genetic studies were selected, of which nineteen involved antiplatelet therapy after PCI. A universal group consisting of clopidogrel and other drugs was used as the baseline and compared with the drug selection groups based on the CYP2C19 LOF allele. The incremental cost–effectiveness ratio was generally below 50,000 (US$/Qaly), and drug selection based on the CYP2C19 LOF allele was the most cost-effective, followed by universal clopidogrel. Although cardiac genetic and economic data are rudimentary, this review indicates that antiplatelet therapy (drug selection based on the CYP2C19 LOF allele) after PCI is generally cost-effective.

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Section: Literature Search Resultsmentioning

confidence: 99%

Consideration of the Medical Economics of Cardiac Genetics, Focusing on the Cost-Effectiveness of P2Y12 Inhibitor Selection Based on the CYP2C19 Loss-of-Function Allele: A Semi-Systematic Review

Takura

2024

Cardiogenetics

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“…Several cost-effectiveness and risk-benefit analyses were performed to examine the economic value of CYP2C19 genotype-guided antiplatelet therapy in patients with acute coronary syndrome in different countries but not in Korea (Reese et al 2012;Sorich et al 2013;Kazi et al 2014;Deiman et al 2016;Wang et al 2018;Fu et al 2020;Limdi et al 2020;Narasimhalu et al 2020;AlMukdad et al 2021;Kim et al 2021;Claassens et al 2022). Although there are several studies already done evaluating the cost-effectiveness, it is important to have economic evaluation for each country reflecting its own healthcare system and most importantly reflecting racial characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Several cost-effectiveness studies have been published in various countries (Reese et al 2012;Deiman et al 2016;Fu et al 2020;Narasimhalu et al 2020;AlMukdad et al 2021;Claassens et al 2022). The objective of this study was to evaluate the cost-effectiveness of a CYP2C19 gen-otype-guided antiplatelet therapy reflecting the characteristics of Asians when compared with using clopidogrel or prasugrel without considering genotypes in patients with acute coronary syndrome scheduled to undergo percutaneous coronary intervention in Korea.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Genotype-Guided Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention in Korea

Suh,

Lee,

Lee

et al. 2024

DTT

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We aimed to evaluate the cost-effectiveness of the cytochrome p450 (CYP) 2C19 genotype-guided antiplatelet therapy compared with using clopidogrel or prasugrel without considering genotypes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in Korea. We performed a cost-effectiveness analysis using a decision analytic model with a one-year time period employing a societal perspective. A cohort of 10,000 patients was assigned to each treatment alternative as follows: (1) selecting antiplatelet therapy between clopidogrel and prasugrel utilizing the genotype information of CYP2C19; (2) using clopidogrel without using genotype information; (3) using prasugrel without using genotype information. The primary outcome measure was the incremental cost per effectiveness ratio (ICER), where the effectiveness was defined as a death or cardiovascular event avoided, comparing genotype-guided therapy with the other two alternatives. The cardiovascular event was defined as any occurrence of nonfatal myocardial infarction, nonfatal stroke, and bleeding. The secondary outcome measures were the incidence of each event for each alternative and the number needed to treat (NNT) with the genotype-guided therapy versus each of other alternatives. The treatment strategy of genotype-guided therapy was dominant when compared with using clopidogrel (ICER: −36,610,303 KRW, −33,282 USD) or prasugrel (ICER: −24,202,531 KRW, −22,002 USD) for all patients without considering the genotype. The NNT of the genotype-guided therapy versus clopidogrel and prasugrel for all patients was 26 and 12, respectively, for any occurrence of death and cardiovascular event. Genotype-guided antiplatelet therapy in patients with acute coronary syndrome appeared to be a cost-effective treatment strategy in Korean patients.

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“…This study and existing literature 26 indicate that CYP2C19 genotype‐guided antiplatelet therapy would be a potentially beneficial treatment for patients with stroke, even though the assumptions and structure of the model are different from the previous studies. The association between CYP2C19 LOF alleles and poor clinical outcomes in patients with cardiovascular disease has been established, 43,44 and most published cost‐effectiveness analyses focus on CYP2C19 genotype‐guided antiplatelet therapy in this field, indicating that, in many cases, CYP2C19 genotype‐guided antiplatelet therapy is a favourable treatment therapy for patients with cardiovascular disease, such as acute coronary syndrome or experiencing percutaneous coronary intervention (PCI) 45–48 . The CYP2C19 genotype‐guided antiplatelet treatment could therefore be a promising option for future tailored medical care.…”

Section: Discussionmentioning

confidence: 99%

“…This study, using a 90-day decision tree model and a 30-year lifetime Markov model, shows that CYP2C19 genotype-guided cilostazol genotype-guided antiplatelet therapy in this field, indicating that, in many cases, CYP2C19 genotype-guided antiplatelet therapy is a favourable treatment therapy for patients with cardiovascular disease, such as acute coronary syndrome or experiencing percutaneous coronary intervention (PCI). [45][46][47][48] The CYP2C19 genotype-guided antiplatelet treatment could therefore be a promising option for future tailored medical care. The results of this study provide empirical evidence for decision-makers to improve stroke treatment.…”

Section: T a B L Ementioning

confidence: 99%

Cost‐effectiveness analysis of CYP2C19 genotype‐guided antiplatelet therapy for patients with acute minor ischemic stroke and high‐risk transient ischemic attack in China

Zhang,

Bao,

et al. 2023

Brit J Clinical Pharma

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AimThe study aimed to estimate the cost‐effectiveness of CYP2C19 genotype‐guided antiplatelet therapy, cilostazol, and ticagrelor as an alternative to clopidogrel.MethodsA 90‐day decision tree and 30‐year Markov model were employed to assess the costs and quality‐adjusted life years (QALYs) of personalized antiplatelet therapy for patients with minor ischemic stroke and high‐risk transient ischemic attack, compared to the conventional antiplatelet therapy in the Chinese healthcare system. The primary outcome was the incremental cost‐effectiveness ratio (ICER). The data sources included clinical trials, published literature, official documents, and local prices. One‐way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings.ResultsThe base‐case analysis indicated that the CYP2C19 genotype‐guided antiplatelet strategy, cilostazol group and ticagrelor group, yielding an ICER of 3327.40 US dollars (USD)/QALY and 3426.92 USD/QALY, respectively, which were less than threshold. The one‐way sensitivity analysis presented the results were robust, where the most sensitive parameter was the disability distribution in the modified Rankin Scale 3‐5. The probabilistic analysis showed that the CYP2C19 genotype‐guided antiplatelet therapy either with cilostazol or with ticagrelor was 100% cost‐effective under the willingness‐to‐pay threshold.ConclusionCYP2C19 genotype‐guided antiplatelet therapy, cilostazol, and ticagrelor as an alternative to clopidogrel, appeared to be more cost‐effective than conventional antiplatelet therapy for acute minor ischemic stroke and high‐risk transient ischemic attack patients over 30 years in China.

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Short- and long-term cost-effectiveness analysis of CYP2C19 genotype-guided therapy, universal clopidogrel, versus universal ticagrelor in post-percutaneous coronary intervention patients in Qatar

Cited by 9 publications

References 44 publications

Consideration of the Medical Economics of Cardiac Genetics, Focusing on the Cost-Effectiveness of P2Y12 Inhibitor Selection Based on the CYP2C19 Loss-of-Function Allele: A Semi-Systematic Review

Consideration of the Medical Economics of Cardiac Genetics, Focusing on the Cost-Effectiveness of P2Y12 Inhibitor Selection Based on the CYP2C19 Loss-of-Function Allele: A Semi-Systematic Review

Cost-Effectiveness Analysis of Genotype-Guided Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention in Korea

Cost‐effectiveness analysis of CYP2C19 genotype‐guided antiplatelet therapy for patients with acute minor ischemic stroke and high‐risk transient ischemic attack in China

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