Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction: Results from the POPular Genetics Trial

Introduction The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y 12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI). Objecti...

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Published in:American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2022-03, Vol.22 (2), p.195-206
Main Authors: Claassens, Daniel M. F., van Dorst, Pim W. M., Vos, Gerrit J. A., Bergmeijer, Thomas O., Hermanides, Renicus S., van ’t Hof, Arnoud W. J., van der Harst, Pim, Barbato, Emanuele, Morisco, Carmine, Tjon Joe Gin, Richard M., Asselbergs, Folkert W., Mosterd, Arend, Herrman, Jean-Paul R., Dewilde, Willem J. M., Postma, Maarten J., Deneer, Vera H. M., ten Berg, Jurriën M., Boersma, Cornelis
Format: Article
Language:English
Subjects:
Angioplasty
Cardiology
Cardiovascular disease
Clinical outcomes
Cost analysis
Cost control
Decision trees
Enzymes
Genetics
Genotype & phenotype
Heart attacks
Medicine
Medicine & Public Health
Mortality
NCT
NCT01761786
Original Research Article
Patients
Pharmacology/Toxicology
Pharmacotherapy
Population
Questionnaires
Stroke
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Summary:Introduction The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y 12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI). Objective In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel. Methods A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y 12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y 12 inhibitors, and equal distribution of thrombotic events between the two strategies). Results Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant. Conclusion In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings. Trial Registration Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872
ISSN:1175-3277
1179-187X
DOI:10.1007/s40256-021-00496-4