title: Cost-effectiveness analysis of personalized antiplatelet therapy in patients with acute coronary syndrome.
abstract: This study aimed to compare the clinical and economic outcomes of pharmacogenetic-guided (PG-guided) and platelet reactivity testing-guided antiplatelet therapy for patients with acute coronary syndrome undergoing percutaneous coronary intervention.
  
  
  
  A decision-analytic model was simulated including four antiplatelet strategies: universal clopidogrel 75 mg daily, universal alternative P2Y12 inhibitor (prasugrel or ticagrelor), PG-guided therapy, and platelet reactivity testing-guided therapy.
  
  
  
  PG-guided therapy was the preferred option with lowest cost (US$75,208) and highest quality-adjusted life years gained (7.6249 quality-adjusted life years). The base-case results were robust in sensitivity analysis.
  
  
  
  PG-guided antiplatelet therapy showed the highest probability to be preferred antiplatelet strategy for acute coronary syndrome patients with percutaneous coronary intervention.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong, China SAR.
authors.forename: Minghuan
authors.initials: M
authors.lastname: Jiang
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong, China SAR.
authors.forename: Joyce Hs
authors.initials: JH
authors.lastname: You
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000235:genetics; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics; D003661:Decision Support Techniques; D016527:Drug Costs; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D000071185:Pharmacogenomic Testing; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D057285:Precision Medicine; D019057:Quality-Adjusted Life Years; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: CYP2C19 genotype; acute coronary syndrome; clopidogrel; cost–effectiveness analysis; personalized antiplatelet therapy; platelet reactivity; prasugrel; ticagrelor