Introduction

The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y₁₂ inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI).

Objective

In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel.

Methods

A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y₁₂ inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y₁₂ inhibitors, and equal distribution of thrombotic events between the two strategies).

Results

Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant.

Conclusion

In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings.

Trial Registration

Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872

中文翻译：

---

CYP2C19 基因型指导策略在急性心肌梗死患者中的成本效益：流行遗传学试验的结果

介绍

POPular Genetics 试验表明，与替格瑞洛或普拉格雷的标准治疗相比，CYP2C19基因型引导的 P2Y ₁₂抑制剂策略可降低出血率，而不会增加初次经皮冠状动脉介入治疗 (PCI) 后的血栓事件发生率。

客观的

在这项分析中，我们旨在评估基因型指导策略与替格瑞洛或普拉格雷的标准治疗相比的成本效益。

方法

开发了一种基于 POPular Genetics 试验并结合终身马尔可夫模型的 1 年决策树，以比较基因型指导和标准 P2Y ₁₂之间的成本和质量调整生命年 (QALY)接受直接 PCI 的心肌梗死患者的抑制剂策略。成本效益分析是从荷兰医疗保健系统的角度进行的。试验内生存率和效用数据与终生预测相结合，以评估 1000 名患者队列的终生成本效益。根据荷兰卫生经济学研究指南，成本和水电费分别贴现了 4% 和 1.5%。除了确定性和概率敏感性分析外，还进行了几种情景分析（不同的时间范围、不同的贴现率、P2Y ₁₂抑制剂的相同价格以及两种策略之间血栓事件的均等分布）。

结果

对 1000 名受试者的假设队列进行的基本案例分析表明，基因型引导策略（占主导地位）获得了 8.98 个 QALY，并节省了 725,550.69 欧元的成本。确定性和概率敏感性分析证实了模型的稳健性和成本效益结果。在情景分析中，基因型引导策略仍然占主导地位。

结论

在接受直接 PCI 的患者中，与使用替格瑞洛或普拉格雷的标准治疗相比，CYP2C19基因型指导策略可提高 QALY 并节省成本。

试用注册

Clinicaltrials.gov 编号：NCT01761786，荷兰试验注册编号：NL2872