Cost-effectiveness of CYP2C19-guided antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention informed by real-world data

Limdi, NA; Cavallari, LH; Lee, Craig; Wb, Hillegass; Holmes, AM; Skaar, Todd C.; Pisu, Maria; Dillon, Chrisly; Beitelshees, AL; Empey, Philip E.; Jd, Duarte; Diaby,; Gong, Yan; Ja, Johnson; Graves, John A.; Garbett, Shawn; Zhou, Zilu; Jf, Peterson

doi:10.1038/s41397-020-0162-5

Cited by 33 publications

(34 citation statements)

References 61 publications

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“…Further, emerging data showing frequent reimbursement across multiple payers 26 and cost-effectiveness of genotype testing at the time of PCI support this strategy. 27…”

Section: Discussionmentioning

confidence: 99%

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype‐Guided Antiplatelet Therapy

Empey

Stevenson

Tuteja

et al. 2018

Clin Pharma and Therapeutics

Self Cite

106

135

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CYP2C19 genotype-guided antiplatelet therapy following percutaneous coronary intervention is increasingly implemented in clinical practice. However, challenges such as selecting a testing platform, communicating test results, building clinical decision support processes, providing patient and provider education, and integrating methods to support the translation of emerging evidence to clinical practice are barriers to broad adoption. In this report, we compare and contrast implementation strategies of 12 early adopters, describing solutions to common problems and initial performance metrics for each program. Key differences between programs included the test result turnaround time and timing of therapy changes, which are both related to the CYP2C19 testing model and platform used. Sites reported the need for new informatics infrastructure, expert clinicians such as pharmacists to interpret results, physician champions, and ongoing education. Consensus lessons learned are presented to provide a path forward for those seeking to implement similar clinical pharmacogenomics programs within their institutions.

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“…Further, emerging data showing frequent reimbursement across multiple payers 26 and cost-effectiveness of genotype testing at the time of PCI support this strategy. 27…”

Section: Discussionmentioning

confidence: 99%

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype‐Guided Antiplatelet Therapy

Empey

Stevenson

Tuteja

et al. 2018

Clin Pharma and Therapeutics

Self Cite

106

135

View full text Add to dashboard Cite

show abstract

“…We model the alternative treatments that are not known to have a drug–gene relationship with the indicated genes (NOAC and PCSK9 inhibitor), or have a trace of drug–gene relationship but are found to be cost-effective under genotype-guided strategy (ticagrelor). 15 , 20 , 28 , 29 …”

Section: Methodsmentioning

confidence: 99%

“…As indicated previously, the PGx panel test for the study include the following genes: CYP2C19, CYP2C9/VKORC1, and SLCO1B1. 15,20,28,29 The timelines of the three test strategies are illustrated in Fig. 2.…”

Section: Testing Strategiesmentioning

confidence: 99%

A model-based cost-effectiveness analysis of pharmacogenomic panel testing in cardiovascular disease management: preemptive, reactive, or none?

Zhu

Moriarty

Swanson

et al. 2021

Genetics in Medicine

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Purpose: Pharmacogenomics (PGx) studies how inherited genetic variations in individuals affect drug absorption, distribution, and metabolism. PGx panel testing can potentially help improve efficiency and accuracy in individualizing therapy. This study compared the cost-effectiveness between preemptive PGx panel testing, reactive PGx panel testing and usual care (no testing) in cardiovascular disease management. Methods: We developed a decision analytic model from the US payer's perspective for a hypothetical cohort of 10,000 patients ≥45 years old, using a short-term decision tree and long-term Markov model. The testing panel included the following gene-drug pairs: CYP2C19-clopidogrel, CYP2C9/VKORC1-warfarin, and SLCO1B1-statins with 30 test-return days. Costs were reported in 2019 US dollars and effectiveness was measured in quality-adjusted life years (QALYs). The primary outcome was incremental costeffectiveness ratio (ICER = ΔCost/ΔQALY), assuming 3% discount rate for costs and QALYs. Scenario and probabilistic sensitivity analyses were performed to assess the impact of demographics, risk level, and follow-up timeframe. Results: Preemptive testing was found to be cost-effective compared with usual care (ICER $86,227/QALY) at the willingness-to-pay threshold of $100,000/QALY while reactive testing was not (ICER $148,726/QALY). Sensitivity analyses suggested that our cost-effectiveness results were sensitive to longer follow-up, and the age group 45-64 years. Conclusion: Compared with usual care, preemptive PGx panel testing was cost-effective in cardiovascular disease management.

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“…[ 1 ] A large body of evidence supports this practice, and many studies have found it to be cost effective. [ 2 – 4 ] CYP2C19 codes for the major enzyme responsible for the activation of clopidogrel. Individuals carrying one or two copies of no function variants in CYP2C19 are known as Intermediate and Poor Metabolizers, respectively (~1/3 of the population).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the extent of reusability of CYP2C19 genotype data among patients genotyped for antiplatelet therapy selection

Beitelshees

Stevenson

Rouby

et al. 2020

Genetics in Medicine

Self Cite

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Cost-effectiveness of CYP2C19-guided antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention informed by real-world data

Cited by 33 publications

References 61 publications

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype‐Guided Antiplatelet Therapy

Multisite Investigation of Strategies for the Implementation of CYP2C19 Genotype‐Guided Antiplatelet Therapy

A model-based cost-effectiveness analysis of pharmacogenomic panel testing in cardiovascular disease management: preemptive, reactive, or none?

Evaluating the extent of reusability of CYP2C19 genotype data among patients genotyped for antiplatelet therapy selection

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