Cost-Effectiveness of Multigene Pharmacogenetic Testing in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention.

Publisher: Elsevier Country of Publication: United States NLM ID: 100883818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4733 (Electronic) Linking ISSN: 10983015 NLM ISO Abbreviation: Value Health Subsets: MEDLINE

Publication: Jan./Feb. 2011- : New York : Elsevier
Original Publication: Malden, MA : Blackwell Science, c1998-

Drug Costs* ; Pharmacogenomic Variants*; Acute Coronary Syndrome/*economics ; Acute Coronary Syndrome/*therapy ; Anticoagulants/*economics ; Anticoagulants/*therapeutic use ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*economics ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Percutaneous Coronary Intervention/*economics ; Pharmacogenomic Testing/*economics ; Platelet Aggregation Inhibitors/*economics ; Platelet Aggregation Inhibitors/*therapeutic use; Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/mortality ; Aged ; Anticoagulants/adverse effects ; Cost-Benefit Analysis ; Cytochrome P-450 CYP2C19/genetics ; Cytochrome P-450 CYP2C9/genetics ; Decision Trees ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Liver-Specific Organic Anion Transporter 1/genetics ; Male ; Markov Chains ; Medicare/economics ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/mortality ; Platelet Aggregation Inhibitors/adverse effects ; Precision Medicine/economics ; Predictive Value of Tests ; Quality-Adjusted Life Years ; Reproducibility of Results ; Risk Factors ; Time Factors ; Treatment Outcome ; United States ; Vitamin K Epoxide Reductases/genetics

Objective: To evaluate the cost-effectiveness of multigene testing (CYP2C19, SLCO1B1, CYP2C9, VKORC1) compared with single-gene testing (CYP2C19) and standard of care (no genotyping) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) from Medicare's perspective.
Methods: A hybrid decision tree/Markov model was developed to simulate patients post-PCI for ACS requiring antiplatelet therapy (CYP2C19 to guide antiplatelet selection), statin therapy (SLCO1B1 to guide statin selection), and anticoagulant therapy in those that develop atrial fibrillation (CYP2C9/VKORC1 to guide warfarin dose) over 12 months, 24 months, and lifetime. The primary outcome was cost (2016 US dollar) per quality-adjusted life years (QALYs) gained. Costs and QALYs were discounted at 3% per year. Probabilistic sensitivity analysis (PSA) varied input parameters (event probabilities, prescription costs, event costs, health-state utilities) to estimate changes in the cost per QALY gained.
Results: Base-case-discounted results indicated that the cost per QALY gained was $59 876, $33 512, and $3780 at 12 months, 24 months, and lifetime, respectively, for multigene testing compared with standard of care. Single-gene testing was dominated by multigene testing at all time horizons. PSA-discounted results indicated that, at the $50 000/QALY gained willingness-to-pay threshold, multigene testing had the highest probability of cost-effectiveness in the majority of simulations at 24 months (61%) and over the lifetime (81%).
Conclusions: On the basis of projected simulations, multigene testing for Medicare patients post-PCI for ACS has a higher probability of being cost-effective over 24 months and the lifetime compared with single-gene testing and standard of care and could help optimize medication prescribing to improve patient outcomes.
(Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Keywords: acute coronary syndrome; multigene testing; pharmacogenetics; precision medicine

0 (Anticoagulants)
0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
0 (Liver-Specific Organic Anion Transporter 1)
0 (Platelet Aggregation Inhibitors)
0 (SLCO1B1 protein, human)
EC 1.14.13.- (CYP2C9 protein, human)
EC 1.14.13.- (Cytochrome P-450 CYP2C9)
EC 1.14.14.1 (CYP2C19 protein, human)
EC 1.14.14.1 (Cytochrome P-450 CYP2C19)
EC 1.17.4.4 (VKORC1 protein, human)
EC 1.17.4.4 (Vitamin K Epoxide Reductases)

Date Created: 20200119 Date Completed: 20200622 Latest Revision: 20200622

20221213

10.1016/j.jval.2019.08.002

31952675