Cost-effectiveness of CYP2C19 -guided P2Y12 inhibitors in Veterans undergoing percutaneous coronary intervention for acute coronary syndromes
Authors' conclusion
In Veterans post-ACS/PCI, CYP2C19-guided P2Y12 inhibitor selection can improve CV outcomes and lower costs for the VHA within 12 months of implementation.
Study context
- Population
- Hypothetical Veterans receiving a P2Y12 inhibitor for 12 months post-ACS/PCI
- Participants
- 2,800 hypothetical Veterans
- Comparison
- CYP2C19 testing vs no testing
- Outcome
- Cost (2020 US$) per QALY gained
- Follow-up
- 12 months
Methodological detailsdecision-analytic model, Veterans Health Administration perspective, probabilistic sensitivity analyses, scenario analyses
- Decision-analytic model
- Veterans Health Administration perspective
- Probabilistic sensitivity analyses
- Scenario analyses
Main finding
As reported in the abstract
Cost per QALY gained
CYP2C19 testing dominant in base case: Quality-adjusted life year (QALYs) gained
0.0027
Saved per person
$527
Dominant in simulations
97.1%
Further findings
Therapy changes with CYP2C19 guidance
- Escalations (clopidogrel to prasugrel/ticagrelor)
- 496 (24%)
- De-escalations (prasugrel/ticagrelor to clopidogrel)
- 465 (65%)
Clinical events averted by CYP2C19 testing
- Strokes averted
- 1
- MIs averted
- 27
- Cardiovascular (CV) deaths averted
- 8
Scenario analyses
- De-escalation with escalation required for testing to be cost-effective and high-value
Safety
Bleeds caused by CYP2C19 testing
- Bleeds caused
- 3
Original publication
Cost-effectiveness of CYP2C19 -guided P2Y12 inhibitors in Veterans undergoing percutaneous coronary intervention for acute coronary syndromes. Eur Heart J Qual Care Clin Outcomes. Published 2 June 2022. doi:10.
Summarised from the published abstract; every number is checked against it