title: Economic Evaluation of a Pharmacogenomics Test for Statin-Induced Myopathy in Cardiovascular High-Risk Patients Initiating a Statin.
abstract: Statins are the mainstay hypercholesterolemia treatment and reduce the risk of cardiovascular events in patients. However, statin therapy is often interrupted in patients experiencing musculoskeletal pain or myopathy, which are common in this patient group. Currently, the standard tests for diagnosing statin myopathies are difficult to interpret. A pharmacogenomics (PGx) test to diagnose statin-induced myopathy would be highly desirable.
  
  
  
  We developed a Markov state model to assess the cost-effectiveness of a hypothetical PGx test, which aims to identify statin-induced myopathy in high-risk, secondary prevention cardiovascular patients. The alternative strategy hypothesized is that physicians or patients interrupt the statin therapy in the presence of musculoskeletal pain. Our model includes health states specific to the PGx test outcome which assesses the impact of test errors.
  
  
  
  Assuming a perfect test, the results indicate that the PGx test strategy dominates when the test costs less than CAN$356, when the strategy is cost neutral. These results are robust to deterministic and probabilistic sensitivity analyses.
  
  
  
  Our base-case results show that a PGx test for statin-induced myopathy in a high-risk, secondary prevention of a cardiovascular event population would be a dominant solution for a test cost of CAN$356 or less. Furthermore, the modelling of the complete range of diagnostic test outcomes provide a broader understanding of the economic value of the pharmacogenomics test.
authors: Faculté de médecine, Université de Montréal, Montréal, Canada.|Centre de recherche du Centre hospitalier de l'université de Montréal, 800 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
authors: Dominic
authors: D
authors: Mitchell
authors: Programs for Assessment of Health Technology in Health Research Institute, Hamilton, ON, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Jason R
authors: JR
authors: Guertin
authors: Faculté de médecine, Université de Montréal, Montréal, Canada.|Centre de recherche du Centre hospitalier de l'université de Montréal, 800 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
authors: Ange Christelle
authors: AC
authors: Iliza
authors: Faculté de médecine, Université de Montréal, Montréal, Canada.|Centre de recherche du Centre hospitalier de l'université de Montréal, 800 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
authors: Fiorella
authors: F
authors: Fanton-Aita
authors: Faculté de médecine, Université de Montréal, Montréal, Canada. jacques.le.lorier@umontreal.ca.|Centre de recherche du Centre hospitalier de l'université de Montréal, 800 rue St-Denis, Montréal, QC, H2X 0A9, Canada. jacques.le.lorier@umontreal.ca.
authors: Jacques
authors: J
authors: LeLorier
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006937:Hypercholesterolemia / Q000188:drug therapy; D008962:Models, Theoretical; D009135:Muscular Diseases / Q000139:chemically induced / Q000175:diagnosis*; D010597:Pharmacogenetics / Q000191:economics* / Q000379:methods*; D012680:Sensitivity and Specificity
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors