NDLI: Cost-effectiveness of cytochrome P450 2C19 genotype screening for selection of antiplatelet therapy with clopidogrel or prasugrel.

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Cost-effectiveness of cytochrome P450 2C19 genotype screening for selection of antiplatelet therapy with clopidogrel or prasugrel.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Reese, Emily S. Daniel Mullins, C. Beitelshees, Amber L. Onukwugha, Eberechukwu
Description	Country affiliation: United States Author Affiliation: Reese ES ( School of Pharmacy, University of Maryland, Baltimore, Maryland, USA. erees001@umaryland.edu)
Abstract	STUDY OBJECTIVE: To estimate the cost-effectiveness of genotype-guided selection of antiplatelet therapy compared with selecting clopidogrel or prasugrel irrespective of genotype. DESIGN: Decision model based on event occurrence in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38. PATIENTS: Simulated cohort of patients with acute coronary syndrome scheduled to undergo percutaneous coronary intervention (PCI), consisting of three arms: those receiving genotype-guided antiplatelet therapy with clopidogrel or prasugrel, those receiving clopidogrel regardless of genotype, and those receiving prasugrel regardless of genotype. MEASUREMENTS AND MAIN RESULTS: All three arms of the model incorporated the probability that patients would experience a cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke), a bleeding event (major or minor bleeding), or no event while receiving antiplatelet therapy during the 15 months after the scheduled PCI. The cytochrome P450 (CYP) 2C19 genotype determined antiplatelet drug selection in the genotyping group. Cost-effectiveness was expressed as the incremental cost-effectiveness ratio (ICER) for each event avoided in the genotype-guided therapy arm versus the other two arms. Genotype-guided antiplatelet therapy was dominant, or more effective and less costly, when compared with the selection of clopidogrel (ICER -\$6760 [95% confidence interval (CI) -\$6720 to -\$6790]) or prasugrel (ICER -\$11,710 [95% CI -\$11,480 to -\$11,950]) for all patients without regard to genotype. Genotype-guided therapy that included generic clopidogrel was dominant to prasugrel for all patients (ICER -\$27,160 [95% CI -\$27,890 to -\$26,420]). Cost savings were not evident when genotype-guided therapy that included generic clopidogrel was compared with generic clopidogrel for all patients (ICER \$2300 [95% CI \$2290 to \$2320]). [Correction added after online publication 12-Mar-2012: In the previous sentence -\$2300 has been corrected as \$2300.]. CONCLUSION: Genotype-guided antiplatelet therapy selection may be more cost-effective and may provide more clinical value due to fewer adverse outcomes.
File Format	HTM / HTML
ISSN	02770008
e-ISSN	18759114
DOI	10.1002/j.1875-9114.2012.01048
Journal	Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Issue Number	4
Volume Number	32
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2012-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Pharmacology Aryl Hydrocarbon Hydroxylases Genetics Piperazines Therapeutic Use Platelet Aggregation Inhibitors Thiophenes Thrombolytic Therapy Ticlopidine Analogs & Derivatives Acute Coronary Syndrome Drug Therapy Cardiovascular Diseases Computer Simulation Cost-benefit Analysis Cytochrome P-450 Cyp2c19 Decision Trees Drugs, Generic Genotype Hemorrhage Chemically Induced Models, Economic Models, Statistical Myocardial Infarction Adverse Effects Prasugrel Hydrochloride Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Pharmacology (medical)

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