Abstract 13112: The Cost Effectiveness of Genetic Testing for CYP2C19 Variants to Guide Treatment in Patients with Acute Coronary Syndromes
Introduction: Patients with acute coronary syndromes and the reduced function allele CYP2C19*2 (*2 allele) treated with thienopyridines have an increased risk of adverse cardiac events with clopidogrel, but not with prasugrel. This study evaluated, in the New Zealand setting, the cost effectiveness of generic clopidogrel in all patients, compared with prasugrel for all patients, and also compared with the guided use of prasugrel in *2 allele patients.
Methods: Clinical outcome data comparing clopidogrel and prasugrel from the TRITON-TIMI 38 trial was combined with rates of the *2 allele in Maori (24%), Pacific Islanders (45%), Asian (29%), and New Zealand Europeans (15%). National hospital DRG discharge codes were used to determine the incidence and costs of hospitalizations for stroke, MI, bleeding, stent thrombosis, and cardiovascular death during the 15 months after patients presented with an acute coronary syndrome. Decision tree modeling and Monte Carlo simulations were used.
Results: The cost of medications and hospitalizations during the 15 months post ACS was estimated to be $403 and $16,717, respectively, for each patient in New Zealand, with 8.5 QALYs. Treating all with patients with prasugrel was associated with higher cost and lower QALYs, but use of a genetic test to guide the selected use of prasugrel was cost effective in the New Zealand population (NZ $8,542/QALY), particularly for Maori (NZ $7,211/QALY) and Pacific Islanders (NZ $6,966/QALY). Prasugrel is less cost effective than clopidogrel when used in all patients.
Conclusions: Use of a genetic test to guide thienopyridine treatment in patients with acute coronary syndromes is a cost effective treatment strategy, especially for ethnic groups with a high frequency of the CYP2C19*2 variant.
- © 2010 by American Heart Association, Inc.