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Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis

Abstract

We constructed a cost-effectiveness model to assess the clinical and economic value of a CDS alert program that provides pharmacogenomic (PGx) testing results, compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF), from a health system perspective. We defaulted that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated over 20 years with an annual discount rate of 3%. In total, 3169 alerts would be fired. The CDS alert program would help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was $39,477/QALY. A PGx-CDS alert program was cost-effective, under a willingness-to-pay threshold of $100,000/QALY gained, compared to no alert program.

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Fig. 1: Model schematics.
Fig. 2: One-way probabilistic sensitivity analysis (OWSA).
Fig. 3: Cost-effectiveness acceptability curve (CEAC).

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Data availability

All data used in the model are publicly available and available by directly contacting the authors, as well as being included in the manuscript.

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Funding

This project was funded by Agency for Healthcare Research and Quality (AHRQ) R21-HS26544.

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SJ was responsible for performing literature review, analyzing data, and manuscript preparation. SJ, PCM, NH, DV and BD developed the cost-utility model. PCM, BHS, PTH, DV, DM, and BD contributed to research development. All authors provided with constructive suggestions in the manuscript. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Beth Devine.

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The authors declare no competing interests.

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Jiang, S., Mathias, P.C., Hendrix, N. et al. Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis. Pharmacogenomics J 22, 188–197 (2022). https://doi.org/10.1038/s41397-022-00275-7

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