title: Review of pharmacoeconomic evaluation of genotype-guided antiplatelet therapy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: The Chinese University of Hong Kong, School of Pharmacy, Faculty of Medicine , Shatin, N.T, Hong Kong , China.
authors: Minghuan
authors: M
authors: Jiang
authors: Joyce H S
authors: JH
authors: You
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000191:economics*; D000241:Adenosine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D005838:Genotype; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010879:Piperazines / Q000191:economics / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D011110:Polymorphism, Genetic; D000068799:Prasugrel Hydrochloride; D018570:Risk Assessment; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: CYP2C19; clopidogrel; cost-effectiveness; pharmacogenetics; prasugrel; ticagrelor