title: Cost-effectiveness of using CYP2C19 genotype to guide selection of clopidogrel or ticagrelor in Australia.
abstract: OBJECTIVE
  This study aims to assess the cost-effectiveness in Australia of screening CYP2C19 loss-of-function (LoF) alleles to guide selection of clopidogrel or ticagrelor for individuals with acute coronary syndrome who are likely to undergo coronary stenting.
  
  
  METHODS
  Three treatment strategies were compared: universal clopidogrel therapy, universal ticagrelor therapy and genotyping CYP2C19 with use of ticagrelor for individuals with a LoF allele and clopidogrel for individuals without a LoF allele. Lifetime costs and quality-adjusted life years for each treatment strategy were estimated using a Markov model. The risks of events were primarily derived from the genetic substudy of the pivotal randomized controlled trial.
  
  
  RESULTS
  CYP2C19 genotyping resulted in greater effectiveness and was cost-effective when compared with universal use of clopidogrel. However, universal use of ticagrelor was the most effective strategy overall and the incremental cost-effectiveness compared with the genotyping strategy was generally within what is considered acceptable.
  
  
  CONCLUSIONS
  Ticagrelor is likely to be cost-effective even for individuals not carrying a CYP2C19 LoF allele.
authors.affiliation: School of Pharmacy & Medical Sciences, University of South Australia, Adelaide, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sorich
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
authors.forename: Wassana
authors.initials: W
authors.lastname: Sorich
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wiese
authors.forename: Brita
authors.initials: B
authors.lastname: Pekarsky
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Karnon
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000483:Alleles; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D001315:Australia; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis / Q000191:economics*; D065731:Cytochrome P-450 CYP2C19; D005838:Genotype; D006801:Humans; D008390:Markov Chains; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine