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Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy

Minghuan Jiang1, Joyce H S You

  • 1The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine , Shatin, N.T, Hong Kong , China.

Expert Opinion on Pharmacotherapy
|February 10, 2015
PubMed
Abstract

Insights

Genotype-guided antiplatelet therapy, using CYP2C19 loss-of-function (LOF) alleles, is cost-effective for acute coronary syndrome (ACS) patients. This approach optimizes treatment with newer agents like prasugrel and ticagrelor, especially in high-risk individuals.

Area of Science:

  • Pharmacogenomics
  • Cardiovascular Medicine
  • Health Economics

Background:

  • Clopidogrel, a common antiplatelet, requires CYP enzyme activation.
  • CYP2C19 loss-of-function (LOF) alleles reduce clopidogrel effectiveness.
  • Newer agents like prasugrel and ticagrelor are not affected by CYP2C19 LOF alleles.

Purpose of the Study:

  • To review pharmacoeconomic studies on genotype-guided antiplatelet therapy in acute coronary syndrome (ACS).
  • To evaluate the cost-effectiveness of using CYP2C19 genotype to guide the selection of antiplatelet agents.

Main Methods:

  • Literature search conducted from 2000 to 2014.
  • Reviewed seven studies on cost-effectiveness and risk-benefit analyses.
  • Focused on CYP2C19 genotype-guided antiplatelet therapy in ACS patients.

Main Results:

  • Genotype-guided prasugrel was cost-effective versus universal therapy in four studies.
  • Genotype-guided ticagrelor was cost-effective in ACS patients undergoing percutaneous coronary intervention (PCI).
  • Universal ticagrelor was cost-effective in ACS patients.
  • Drug costs and relative risks influenced cost-effectiveness.

Conclusions:

  • Studies focused on antiplatelet selection for CYP2C19 LOF allele carriers.
  • Genotype-guided antiplatelet use demonstrated cost-effectiveness in high-risk ACS patients.
Keywords:
CYP2C19clopidogrelcost-effectivenesspharmacogeneticsprasugrelticagrelor

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