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Cost-effectiveness of cytochrome P450 2C19 *2 genotype-guided selection of clopidogrel or ticagrelor in Chinese patients with acute coronary syndrome

The Pharmacogenomics Journal volume 18, pages 113–120 (2018)Cite this article

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Abstract

The choice of antiplatelet therapy among Asian populations for the treatment of acute coronary syndrome (ACS) is complicated owing to the high prevalence of cytochrome P450 2C19 (CYP2C19) genetic polymorphism that has been associated with reduced efficacy of clopidogrel. Ticagrelor is a potent but more expensive alternative antiplatelet agent that is not affected by CYP2C19 polymorphism. This study aimed to evaluate the cost-effectiveness, from the Hong Kong health-care provider’s perspective, of CYP2C19*2 genotype-guided selection of antiplatelet therapy compared with the universal use of clopidogrel or ticagrelor among ACS patients who undergo percutaneous coronary intervention (PCI). In the present study, a two-part model consisting of a 1-year decision tree and a lifetime Markov model was built to simulate the progress of a typical cohort of 60-year-old Chinese patients until age 85 years and compare three treatment strategies: (i) generic clopidogrel or ticagrelor based on CYP2C19*2 genotype, (ii) universal use of generic clopidogrel or (iii) universal use of ticagrelor for all patients. Incremental cost-effectiveness ratios (ICERs) of <1 gross domestic product per capita locally (US dollar (USD)42 423/quality-adjusted life year (QALY)) were considered cost-effective. Base–case results showed universal ticagrelor use was cost-effective compared with universal clopidogrel, but was dominated by genotype-guided treatment. Genotype-guided treatment was cost-effective compared with universal clopidogrel use (ICER of USD2560/QALY). Sensitivity analysis demonstrated that with the cost of genotype testing up to USD400, CYP2C19*2 genotype-guided antiplatelet treatment remained a cost-effective strategy compared with either universal use of generic clopidogrel or ticagrelor in post-PCI ACS patients in Hong Kong.

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Acknowledgements

This study is funded by a Hong Kong Research Grant Council General Research Fund (reference 478709). All authors contributed extensively to the work presented in this paper. We acknowledge the contribution of Dr Lally Lai Yee Chan for identifying and collecting the unit costs used in the analysis. The abstract of this manuscript was published at an international meeting.

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Authors and Affiliations

  1. School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Y Wang & V W Y Lee

  2. Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China

    B P Yan

  3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    D Liew

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Correspondence to V W Y Lee.

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Wang, Y., Yan, B., Liew, D. et al. Cost-effectiveness of cytochrome P450 2C19 *2 genotype-guided selection of clopidogrel or ticagrelor in Chinese patients with acute coronary syndrome. Pharmacogenomics J 18, 113–120 (2018). https://doi.org/10.1038/tpj.2016.94

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