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Cost-effectiveness of CYP2C19-guided antiplatelet therapy for acute coronary syndromes in Singapore

The Pharmacogenomics Journal volume 21, pages 243–250 (2021)Cite this article

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Abstract

We evaluated the cost-effectiveness of a genotype-guided strategy among patients with acute coronary syndromes using a decision-tree model based on the Singapore healthcare payer’s perspective over a 1-year time horizon. Three dual antiplatelet strategies were considered: universal clopidogrel, genotype-guided, and universal ticagrelor. The prevalence of loss-of-function alleles was assumed to be 61.7% and model inputs were identified from the literature. Our primary outcome of interest was incremental cost-effectiveness ratio (ICER) compared to universal clopidogrel. Both genotype-guided (72,158 SGD/QALY) and universal ticagrelor (82,269 SGD/QALY) were considered cost-effective based on a willingness-to-pay (WTP) threshold of SGD 88,991. In our secondary analysis, the ICER for universal ticagrelor was 114,998 SGD/QALY when genotype-guided was taken as a reference. Probabilistic sensitivity analysis revealed that genotype-guided was the most cost-effective strategy when the WTP threshold was between SGD 70,000 to 100,000. Until more data are available, our study suggests that funding for a once-off CYP2C19 testing merits a consideration over 1 year of universal ticagrelor.

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Fig. 1: Simplified decision-tree model.
Fig. 2: Scatter plot of cost against utility for all DAPT strategies.
Fig. 3: Tornado diagrams for all base case ICERs.
Fig. 4: Results from probabilistic sensitivity analyses.
Fig. 5: NMB curves.

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Authors and Affiliations

  1. Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, 768828, Singapore

    Ji Heon Kim & Doreen Su-Yin Tan

  2. Department of Cardiology, Yong Loo-Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore

    Mark Yan Yee Chan

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Correspondence to Ji Heon Kim.

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Kim, J.H., Tan, D.SY. & Chan, M.Y.Y. Cost-effectiveness of CYP2C19-guided antiplatelet therapy for acute coronary syndromes in Singapore. Pharmacogenomics J 21, 243–250 (2021). https://doi.org/10.1038/s41397-020-00204-6

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