Key result
Universal use of ticagrelor was the most effective strategy overall, and its incremental cost-effectiveness compared with CYP2C19 genotyping was generally acceptable.
Why the study?
Does CYP2C19 genotyping to guide selection of clopidogrel or ticagrelor improve cost-effectiveness compared to universal clopidogrel or universal ticagrelor in individuals with acute coronary syndrome likely to undergo coronary stenting?
Does CYP2C19 genotyping to guide selection of clopidogrel or ticagrelor improve cost-effectiveness compared to universal clopidogrel or universal ticagrelor in individuals with acute coronary syndrome likely to undergo coronary stenting?
Universal ticagrelor therapy is likely to be cost-effective even for individuals not carrying a CYP2C19 loss-of-function allele, outperforming a genotype-guided strategy.
Does not support shifting to genotype-guided therapy; leaves open validation in randomized cost-effectiveness trials.
AIMS: This study aims to assess the cost-effectiveness in Australia of screening CYP2C19 loss-of-function (LoF) alleles to guide selection of clopidogrel or ticagrelor for individuals with acute coronary syndrome who are likely to undergo coronary stenting. METHODS: Three treatment strategies were compared: universal clopidogrel therapy, universal ticagrelor therapy and genotyping CYP2C19 with use of ticagrelor for individuals with a LoF allele and clopidogrel for individuals without a LoF allele. Lifetime costs and quality-adjusted life years for each treatment strategy were estimated using a Markov model. The risks of events were primarily derived from the genetic substudy of the pivotal randomized controlled trial. RESULTS: CYP2C19 genotyping resulted in greater effectiveness and was cost-effective when compared with universal use of clopidogrel. However, universal use of ticagrelor was the most effective strategy overall and the incremental cost-effectiveness compared with the genotyping strategy was generally within what is considered acceptable. CONCLUSION: Ticagrelor is likely to be cost-effective even for individuals not carrying a CYP2C19 LoF allele.
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Sorich et al. (2013) studied Acute coronary syndrome. CYP2C19 genotyping to guide selection of clopidogrel or ticagrelor vs. Universal clopidogrel therapy and universal ticagrelor therapy was evaluated on Lifetime costs and quality-adjusted life years (cost-effectiveness). Universal use of ticagrelor was the most effective strategy overall, and its incremental cost-effectiveness compared with CYP2C19 genotyping was generally acceptable.
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