title: Economic analysis of pharmacogenomic-guided clopidogrel treatment in Serbian patients with myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  Clopidogrel, which is activated by the CYP2C19 enzyme, is among the drugs for which all major regulatory agencies recommend genetic testing to be performed to identify a patient's CYP2C19 genotype in order to determine the optimal antiplatelet therapeutic scheme. The CYP2C19*2 and CYP2C19*3 variants are loss-of-function alleles, leading to abolished CYP2C19 function and thus have the risk of thrombotic events for carriers of these alleles on standard dosages, while the CYP2C19*17 allele results in CYP2C19 hyperactivity.
  
  
  OBJECTIVE
  Here, we report our findings from a retrospective study to assess whether genotyping for the CYP2C19*2 allele was cost effective for myocardial infarction patients receiving clopidogrel treatment in the Serbian population compared with the nongenotype-guided treatment.
  
  
  RESULTS
  We found that 59.3% of the CYP2C19*1/*1 patients had a minor or major bleeding event versus 42.85% of the CYP2C19*1/*2 and *2/*2, while a reinfarction event occurred only in 2.3% of the CYP21C9*1/*1 patients, compared with 11.2% of the CYP2C19*1/*2 and CYP2C19*2/*2 patients. There were subtle differences between the two patient groups, as far as the duration of hospitalization and rehabilitation is concerned, in favor of the CYP2C19*1/*1 group. The mean cost for the CYP2C19*1/*1 patients was estimated at €2547 versus €2799 in the CYP2C19*1/*2 and CYP2C19*2/*2 patients. Furthermore, based on the overall CYP2C19*1/*2 genotype frequencies in the Serbian population, a break-even point analysis indicated that performing the genetic test prior to drug prescription represents a cost-saving option, saving €13 per person on average.
  
  
  CONCLUSIONS
  Overall, our data demonstrate that pharmacogenomics-guided clopidogrel treatment may represent a cost-saving approach for the management of myocardial infarction patients undergoing primary percutaneous coronary intervention in Serbia.
authors: Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Christina
authors: C
authors: Mitropoulou
authors: Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece.|National School of Public Health, Athens, Greece.
authors: Vasilios
authors: V
authors: Fragoulakis
authors: Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia.
authors: Ljiljana B
authors: LB
authors: Rakicevic
authors: Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia.
authors: Mirjana M
authors: MM
authors: Novkovic
authors: Economics Department, University of Piraeus, Piraeus, Greece.
authors: Athanassios
authors: A
authors: Vozikis
authors: Emergency Department, Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Dragan M
authors: DM
authors: Matic
authors: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
authors: Nebojsa M
authors: NM
authors: Antonijevic
authors: Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia.
authors: Dragica P
authors: DP
authors: Radojkovic
authors: Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Ron H
authors: RH
authors: van Schaik
authors: Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece.
authors: George P
authors: GP
authors: Patrinos
keywords: Serbian population; clopidogrel; economic evaluation; myocardial infarction; pharmacogenomics