Key result
Genetic testing for clopidogrel resistance saves costs and increases QALYs after ischemic stroke or TIA.
Why the study?
Genetic variants can hinder clopidogrel metabolism, but whether genetic testing for clopidogrel resistance is cost-effective compared with no testing remains to be established.
Does clopidogrel resistance genotype testing improve cost-effectiveness and quality-adjusted life-years compared with no testing in patients after ischaemic stroke or transient ischaemic attack?
Systematic Review
Does clopidogrel resistance genotype testing improve cost-effectiveness and quality-adjusted life-years compared with no testing in patients after ischaemic stroke or transient ischaemic attack?
Genotype testing for clopidogrel resistance followed by tailored treatment is cost-saving and increases quality-adjusted life-years in patients after ischemic stroke or TIA.
May support implementing genetic testing post-stroke/TIA; extends cost-effectiveness evidence for genotype-guided antiplatelet therapy.
Background: genetic variants can hinder clopidogrel metabolism. Laboratory-based or point-of-care tests can detect these variants, enabling targeted treatment. Objective: genetic tests? Is genetic testing for clopidogrel resistance cost-effective compared with no testing? Design: Systematic review and economic model. Results: testing strategies were cost-saving and increase quality-adjusted life-years compared with no testing. Both strategies gave similar costs, quality-adjusted life-years and expected net monetary benefit. Conclusions: testing followed by tailored treatment is likely to be effective and cost-effective in both populations. Future work: Accuracy and technical performance of Genedrive. Test failure rate of Genomadix Cube in a National Health Service setting. Value of testing additional loss-of-function alleles. Appropriateness of treatment dichotomy based on loss-of-function alleles. Limitations: Lack of data on Genedrive. No randomised 'test-and-treat' studies of dipyramidole plus aspirin. Study registration: This study is registered as PROSPERO CRD42022357661. Funding: ; Vol. 28, No. 57. See the NIHR Funding and Awards website for further award information.
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Carroll et al. (2024) conducted a systematic review in ischaemic stroke or transient ischaemic attack. clopidogrel resistance genotype testing vs. no testing was evaluated on cost-effectiveness (costs, quality-adjusted life-years, expected net monetary benefit). Genetic testing for clopidogrel resistance followed by tailored treatment was cost-saving and increased quality-adjusted life-years compared with no testing after ischaemic stroke or TIA.
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