Cost-effectiveness of using CYP2C19 genotype to guide selection of clopidogrel or ticagrelor in Australia
| Autor: | John D. Horowitz, Wassana Sorich, Brita Pekarsky, Michael D. Wiese, Michael J. Sorich, Jonathan Karnon |
|---|---|
| Přispěvatelé: | Sorich, Michael J, Horowitz, John D, Sorich, Wassana, Wiese, Michael D, Pekarsky, Brita, Karnon, Jonathan D |
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Ticagrelor
Acute coronary syndrome medicine.medical_specialty Adenosine Ticlopidine Genotype Cost effectiveness Cost-Benefit Analysis genotype ticlopidine CYP2C19 Pharmacology law.invention acute coronary syndrome Randomized controlled trial law Internal medicine Genetics medicine Humans Acute Coronary Syndrome Genotyping Alleles cytochrome P-450 CYP2C19 Markov chains business.industry cost-benefit analysis Australia medicine.disease Clopidogrel Markov Chains Cytochrome P-450 CYP2C19 adenosine alleles Molecular Medicine Aryl Hydrocarbon Hydroxylases business medicine.drug aryl hydrocarbon hydroxylases |
| Popis: | Aims: This study aims to assess the cost–effectiveness in Australia of screening CYP2C19 loss-of-function (LoF) alleles to guide selection of clopidogrel or ticagrelor for individuals with acute coronary syndrome who are likely to undergo coronary stenting. Methods: Three treatment strategies were compared: universal clopidogrel therapy, universal ticagrelor therapy and genotyping CYP2C19 with use of ticagrelor for individuals with a LoF allele and clopidogrel for individuals without a LoF allele. Lifetime costs and quality-adjusted life years for each treatment strategy were estimated using a Markov model. The risks of events were primarily derived from the genetic substudy of the pivotal randomized controlled trial. Results: CYP2C19 genotyping resulted in greater effectiveness and was cost-effective when compared with universal use of clopidogrel. However, universal use of ticagrelor was the most effective strategy overall and the incremental cost–effectiveness compared with the genotyping strategy was generally within what is considered acceptable. Conclusion: Ticagrelor is likely to be cost-effective even for individuals not carrying a CYP2C19 LoF allele. Original submitted 30 May 2013; Revision submitted 16 August 2013 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|