Cost-effectiveness of using CYP2C19 genotype to guide selection of clopidogrel or ticagrelor in Australia

Michael Sorich, John Horowitz, Wassana Sorich, Brita Pekarsky, Jonathan Karnon

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    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. Original submitted 30 May 2013; Revision submitted 16 August 201.

    Original languageEnglish
    Pages (from-to)2013-2021
    Number of pages9
    JournalPharmacogenomics
    Volume14
    Issue number16
    DOIs
    Publication statusPublished - Dec 2013

    Keywords

    • clopidogrel
    • cost-effectiveness
    • cytochrome P450 2C19
    • genotype
    • pharmacogenetics

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