Document Detail

Cost-effectiveness of cytochrome P450 2C19 genotype screening for selection of antiplatelet therapy with clopidogrel or prasugrel.
MedLine Citation:
PMID:  22461122     Owner:  NLM     Status:  MEDLINE    
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.
Emily S Reese; C Daniel Mullins; Amber L Beitelshees; Eberechukwu Onukwugha
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Pharmacotherapy     Volume:  32     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-30     Completed Date:  2012-07-24     Revised Date:  2014-01-29    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  323-32     Citation Subset:  IM    
Copyright Information:
© 2012 Pharmacotherapy Publications, Inc.
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MeSH Terms
Acute Coronary Syndrome / drug therapy
Aryl Hydrocarbon Hydroxylases / genetics*
Cardiovascular Diseases / drug therapy
Computer Simulation
Cost-Benefit Analysis
Decision Trees
Drugs, Generic / economics
Hemorrhage / chemically induced,  economics
Models, Economic
Models, Statistical
Myocardial Infarction / drug therapy
Piperazines / adverse effects,  economics*,  therapeutic use*
Platelet Aggregation Inhibitors / adverse effects,  economics*,  therapeutic use*
Thiophenes / adverse effects,  economics*,  therapeutic use*
Thrombolytic Therapy / economics*
Ticlopidine / adverse effects,  analogs & derivatives*,  economics,  therapeutic use
Grant Support
Reg. No./Substance:
0/Drugs, Generic; 0/Piperazines; 0/Platelet Aggregation Inhibitors; 0/Thiophenes; 34K66TBT99/prasugrel; A74586SNO7/clopidogrel; EC Hydrocarbon Hydroxylases; EC protein, human; OM90ZUW7M1/Ticlopidine
Comment In:
Pharmacotherapy. 2012 Jun;32(6):e170; discussion e170-1   [PMID:  22674743 ]
Pharmacotherapy. 2012 Apr;32(4):299-303   [PMID:  22461119 ]
Erratum In:
Pharmacotherapy. 2012 Jun;32(6):581

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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