A-63 | Cost-Effectiveness of Pharmacogenetically Guided Clopidogrel Therapy After Acute Coronary Syndrome

Clopidogrel is a widely prescribed antiplatelet following percutaneous coronary intervention. Its pharmacologic activity requires bioactivation using the CYP2C19 enzyme and genetic polymorphisms in the CYP2C19 gene result in loss of function (LOF)alleles. We conducted a real-life cost-effectiveness analysis by obtaining pharmacogenetic (PGx) testing for adult patients with ACS requiring stents between Jan-Dec 2022 who received ticagrelor. Testing was done to identify CYP2C19 LOF carriers and metabolic phenotype, which was categorized as ultra-rapid metabolizer [UM], rapid metabolizer [RM], normal metabolizer [NM], intermediate metabolizer [IM] and poor metabolizer [PM]. Patients who were UM, RM, and NM were considered to have normal clopidogrel activation and were de-escalated to clopidogrel 30 days after ACS. Others continued on their initial DAPT. 72.1% of the 43 enrolled patients were male and average age was 63. 72% had normal enzyme activity. PGx testing resulted in de-escalating ticagrelor to clopidogrel in 55.1% of patients. 10.5% experienced a bleed of any severity. The total cost of ticagrelor over the follow-up period was $77,088 while that of clopidogrel was $28,160. De-escalation represented a drug cost savings of $48,928 and a net cost savings of $35,666 after accounting for $13,262 spent on testing (Fig 1). Our cost analysis demonstrates the cost-effectiveness of pharmacogenetically guided antiplatelet therapy following PCI for ACS