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Updated: Jun 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Development of a point-of-care genetic test for effective treatment of ischaemic stroke: an early model-based
Stuart Wright1, John McDermott2,3, Dwaipayan Sen4
1Manchester Centre for Health Economics, The University of Manchester, Manchester, M139PL, UK.
Insights
Pharmacogenetic testing for CYP2C19 loss-of-function alleles in stroke patients is cost-effective. This approach guides antiplatelet treatment, preventing recurrent strokes and saving healthcare resources.
Area of Science:
- Pharmacogenomics
- Health Economics
- Clinical Decision-Making
Background:
- Stroke survivors face a high risk of recurrent strokes.
- Clopidogrel, an antiplatelet, is prescribed for non-cardioembolic stroke but is less effective in patients with CYP2C19 loss-of-function alleles.
- Pharmacogenetic testing can identify these patients to optimize antiplatelet therapy.
Purpose of the Study:
- To estimate the cost-effectiveness of point-of-care pharmacogenetic CYP2C19 testing within the UK National Health System.
- To evaluate the economic impact of guiding antiplatelet prescriptions based on genetic profiles.
Main Methods:
- A decision-analytic model (decision tree and Markov model) was developed in R.
- Compared pharmacogenetic testing strategy against current prescribing practices.
- Estimated healthcare costs and quality-adjusted life years (QALYs); conducted sensitivity analyses.
Main Results:
- The pharmacogenetic testing strategy yielded an additional 0.107 QALYs per patient and saved £512.
- Testing dominated current practice, showing robustness in sensitivity analyses.
- Probabilistic sensitivity analysis indicated a 77% probability of cost-effectiveness and a 62% probability of cost-saving.
Conclusions:
- Point-of-care pharmacogenetic testing for CYP2C19 alleles can improve health outcomes by preventing secondary strokes.
- This strategy has the potential to be cost-saving for the healthcare system.
- Further research directions were informed by this economic analysis.
Abstract:
Background: People who have experienced a stroke are at high risk of recurrent strokes. Clopidogrel is prescribed to people who have had a non-cardioembolic stroke. There is evidence that clopidogrel is not effective for patients with CYP2C19 loss-of-function alleles. Pharmacogenetic testing is a potential strategy to identify such patients and guide prescription of appropriate antiplatelet treatment. This study aimed to provide an early estimate of the cost-effectiveness of using a point-of-care pharmacogenetic CYP2C19 test in the UK National Health System. Methods: A decision-analytic model comprising a linked decision tree and Markov model were created in R comparing pharmacogenetic testing with current prescribing practice. In the pharmacogenetic testing arm, patients identified to have one of three loss-of-function alleles were prescribed modified-release dipyridamole and aspirin or aspirin alone. Indicative data were sourced from reviews of the literature supported by expert consultation to select the most appropriate value for the input parameters. The healthcare costs (£;2021) and quality adjusted life years resulting from each strategy were estimated and the incremental cost-effectiveness of testing calculated. Deterministic threshold analysis and probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the parameter estimates. Results: The pharmacogenetic testing strategy generated 0.107 additional QALYs per patient tested and saved £512. Pharmacogenetic testing dominated current prescribing practice. The results were robust to extreme changes in key input variables. The PSA suggested that there was a 77% chance that pharmacogenetic testing would be cost-effective with a 62% chance it is cost-saving. Conclusions: A point-of-care pharmacogenetic test to guide prescription of clopidogrel for people who have experienced a stroke has the potential to provide a significant health gain by preventing secondary strokes and may save resources in the health system. This early economic analysis has also informed the direction for future research.
