Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy |
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Authors: | Minghuan Jiang Joyce HS You |
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Institution: | 1. The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Shatin, N.T, Hong Kong, China;2. The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine, Shatin, N.T, Hong Kong, China +852 3943 6830;3. +852 2603 5295;4. joyceyou@cuhk.edu.hk |
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Abstract: | Introduction: Clopidogrel is an antiplatelet agent widely prescribed for acute coronary syndrome (ACS), and it is activated by the CYP enzyme system to active metabolite. CYP2C19 loss-of-function (LOF) allele(s) affect the responsiveness of clopidogrel, but not the new antiplatelet agents (prasugrel and ticagrelor). We reviewed the pharmacoeconomic studies on genotype-guided use of new antiplatelet agents. Areas covered: A literature search was conducted between the period of 2000 and 2014. Seven studies including cost-effectiveness and risk-benefit analyses of CYP2C19 genotype-guided antiplatelet therapy in ACS patients were reviewed. Genotype-guided prasugrel was found to be cost-effective when compared with universal antiplatelet therapy in four studies. Three studies showed genotype-guided ticagrelor to be cost-effective in ACS patients with percutaneous coronary intervention (PCI), and universal ticagrelor to be cost-effective in ACS patients. Drug cost of antiplatelet agents and relative risk of the new antiplatelet versus clopidogrel for clinical events were common influential factors of cost-effectiveness analyses. Expert opinion: All studies in the present review focused on selecting antiplatelet agents for carriers of CYP2C19 LOF allele(s). Cost-effectiveness of genotype-guided use of antiplatelets was demonstrated in high-risk ACS patients. |
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Keywords: | clopidogrel cost-effectiveness CYP2C19 pharmacogenetics prasugrel ticagrelor |
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