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Cost-effectiveness analysis of pharmacogenomics-guided clopidogrel treatment in Spanish patients undergoing percutaneous coronary intervention

The Pharmacogenomics Journal volume 19, pages 438–445 (2019)Cite this article

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Abstract

Clopidogrel is an antiplatelet drug given to patients before and after having a percutaneous coronary intervention (PCI). Genomic variants in the CYP2C19 gene are associated with variable enzyme activities affecting drug metabolism and hence, patients with reduced or increased enzymatic function have increased risk of bleeding. We conducted a cost-effectiveness analysis to compare a pharmacogenomics versus a non-pharmacogenomics-guided clopidogrel treatment for coronary artery syndrome patients undergoing PCI in the Spanish healthcare setting. A total of 549 patients diagnosed with coronary artery disease followed by PCI were recruited. Dual antiplatelet therapy was administrated to all patients from 1 to 12 months after PCI. Patients were classified into two groups: the Retrospective group was treated with clopidogrel based on the clinical routine practice and the Prospective group were initially genotyped for the presence of CYP2C19 variant alleles before treatment with those carrying more than one CYP2C19 variant alleles given prasugrel treatment. We collected data on established clinical and health outcome measures, including, per treatment arm: the percentage of patients that suffered from (a) myocardial infraction, (b) major bleeding and minor bleeding, (c) stroke, (d) the number of hospitalization days, and (e) the number of days patients spent in Intensive Care Unit. Our primary outcome measure for the cost-effectiveness analysis was Quality Adjusted Life Years (QALYs). To estimate the treatment cost for each patient, individual data on its resource used were combined with unit price data, obtained from Spanish national sources. The analysis predicts a survival of 0.9446 QALYs in the pharmacogenomics arm and 0.9379 QALYs in the non-pharmacogenomics arm within a 1-year horizon. The cumulative costs per patient were €2971 and €3205 for the Prospective and Retrospective groups, respectively. The main cost driver of total cost in both arms was hospitalization costs. The incremental cost-effectiveness ratio (ICER) was negative indicating that the PGx was a dominant option. Our data show that pharmacogenomics-guided clopidogrel treatment strategy may represent a cost-effective choice compared with non-pharmacogenomics-guided strategy for patients undergoing PCI.

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Acknowledgements

This work encouraged and coordinated by the Genomic Medicine Alliance Health Economics Working Group. The laboratory of B.R.A. is funded by UAEU grant 31R091.

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Authors and Affiliations

  1. The Golden Helix Foundation, London, UK

    Vasilios Fragoulakis & Christina Mitropoulou

  2. Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece

    Marina Bartsakoulia, Konstantina Chalikiopoulou, Konstantina Kehagia, Maria Gkotsi, Eva Katrali, Efthimios Skoufas, Theodora Katsila & George P. Patrinos

  3. University of Granada, San Cecilio University Hospital, Granada, Spain

    Xando Díaz-Villamarín & Cristina L. Dávila-Fajardo

  4. Cardiología, hospital Universitario San Cecilio/hospital Campus de la Salud, Institute for biomedical research, ibs.GRANADA, Granada, Spain

    Jesús Gabriel Sánchez Ramos

  5. Genomics Unit, Centre for Genomics and Oncological Research (GENYO), University of Granada, Health Sciences Technology Park, Granada, Spain

    Luis Javier Martínez-González

  6. Economics Department, University of Piraeus, Piraeus, Greece

    Athanassios Vozikis

  7. Department of Pathology, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, UAE

    Anne John, Bassam R. Ali & George P. Patrinos

  8. Nuffield Department of Population Health, University of Oxford, Health Economics Research Centre, Oxford, UK

    Sarah Wordsworth

  9. Oxford National Institute for Health Biomedical Research Centre, Oxford, UK

    Sarah Wordsworth

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  1. Vasilios Fragoulakis
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  2. Marina Bartsakoulia
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  8. Maria Gkotsi
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  11. Athanassios Vozikis
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  12. Anne John
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  13. Bassam R. Ali
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  14. Sarah Wordsworth
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  15. Cristina L. Dávila-Fajardo
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  16. Theodora Katsila
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  18. Christina Mitropoulou
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Correspondence to George P. Patrinos or Christina Mitropoulou.

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Fragoulakis, V., Bartsakoulia, M., Díaz-Villamarín, X. et al. Cost-effectiveness analysis of pharmacogenomics-guided clopidogrel treatment in Spanish patients undergoing percutaneous coronary intervention. Pharmacogenomics J 19, 438–445 (2019). https://doi.org/10.1038/s41397-019-0069-1

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