Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases
| Autor: | Suzette J. Bielinski, Bijan J. Borah, Liewei Wang, Ricardo L. Rojas, Sue L. Visscher, Richard M. Weinshilboum, Kristi M. Swanson, Jennifer L. St. Sauver, Zhen Wang, Ye Zhu, Larry J. Prokop |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty economic evaluation Cost effectiveness Cost-Benefit Analysis Design elements and principles Disease 030105 genetics & heredity 03 medical and health sciences cardiovascular disease Vitamin K Epoxide Reductases Humans Medicine Precision Medicine Disease management (health) Intensive care medicine cost-effectiveness Genetics (clinical) Cytochrome P-450 CYP2C9 pharmacogenomics business.industry Clopidogrel Pharmacogenomic Testing Cytochrome P-450 CYP2C19 030104 developmental biology disease management Cardiovascular Diseases Pharmacogenetics Pharmacogenomics Economic evaluation Systematic Review Warfarin VKORC1 business |
| Zdroj: | Genetics in Medicine |
| ISSN: | 1098-3600 |
| DOI: | 10.1038/s41436-019-0667-y |
| Popis: | Purpose To examine the evidence on the cost-effectiveness of implementing pharmacogenomics (PGx) in cardiovascular disease (CVD) care. Methods We conducted a systematic review using multiple databases from inception to 2018. The titles and abstracts of cost-effectiveness studies on PGx-guided treatment in CVD care were screened, and full texts were extracted. Results We screened 909 studies and included 46 to synthesize. Acute coronary syndrome and atrial fibrillation were the predominantly studied conditions (59%). Most studies (78%) examined warfarin–CYP2C9/VKORC1 or clopidogrel–CYP2C19. A payer’s perspective was commonly used (39%) for cost calculations, and most studies (46%) were US-based. The majority (67%) of the studies found PGx testing to be cost-effective in CVD care, but cost-effectiveness varied across drugs and conditions. Two studies examined PGx panel testing, of which one examined pre-emptive testing strategies. Conclusion We found mixed evidence on the cost-effectiveness of PGx in CVD care. Supportive evidence exists for clopidogrel–CYP2C19 and warfarin–CYP2C9/VKORC1, but evidence is limited in other drug–gene combinations. Gaps persist, including unclear explanation of perspective and cost inputs, underreporting of study design elements critical to economic evaluations, and limited examination of PGx panel and pre-emptive testing for their cost-effectiveness. This review identifies the need for further research on economic evaluations of PGx implementation. |
| Databáze: | OpenAIRE |
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