Projected Cost-Effectiveness for 2 Gene-Drug Pairs Using a Multigene Panel for Patients Undergoing Percutaneous Coronary Intervention

Value Health. 2019 Nov;22(11):1231-1239. doi: 10.1016/j.jval.2019.05.015. Epub 2019 Oct 16.

Abstract

Background: For patients undergoing percutaneous coronary intervention, gene-drug associations exist relevant to first-line treatment options-antiplatelet agent, clopidogrel, and pain medication, tramadol. Knowledge of genotype information may allow for avoidance of adverse drug events during critical clinical windows.

Objective: This evaluation estimated cost-effectiveness associated with a multi-gene panel pre-emptively testing two genes providing CYP2C19 genotype-guided strategy for antiplatelet therapy, with CYP2D6 genotype-guided pain management, compared to single gene test for CYP2C19 with random assignment for pain treatment, and to no testing (empiric clopidogrel with random assignment for pain treatment).

Methods: Decision analysis modeling was used to project costs from a payer perspective and patient quality-adjusted life years (QALYs) from the three strategies. The model captured composite risks of major adverse cardiovascular events and pain therapy-related adverse drug events and associated utility estimates. We conducted sensitivity analyses to assess influential input parameters.

Results: Over 15 months, multi-gene testing was least costly and yielded more QALYs compared to both single gene and no testing; total incremental costs were $1646 lower with incremental gains of 0.04 QALYs for multi-gene compared with single gene and $11 368 lower with 0.17 QALY gains compared to no test. Base case analyses revealed multi gene was dominant compared to both single gene and no test, as it demonstrated cost savings with increased QALYs.

Conclusions: For these patients, a multi-gene-guided strategy yields a favorable incremental cost-effectiveness ratio compared to the other two treatment strategies. Pre-emptively ascertaining additional gene-drug pair information can inform clinical and economic decision-making at the point of care.

Keywords: cost-effectiveness analysis; multigene panel; percutaneous coronary intervention; pharmacogenetics.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / pharmacokinetics
  • Clopidogrel / adverse effects
  • Clopidogrel / pharmacokinetics
  • Cost-Benefit Analysis
  • Cytochrome P-450 CYP2C19 / genetics*
  • Cytochrome P-450 CYP2D6 / genetics*
  • Decision Support Techniques
  • Genetic Testing / economics*
  • Genetic Testing / methods*
  • Humans
  • Models, Economic
  • Percutaneous Coronary Intervention / methods*
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / pharmacokinetics
  • Quality-Adjusted Life Years
  • Tramadol / adverse effects
  • Tramadol / pharmacokinetics

Substances

  • Analgesics, Opioid
  • Platelet Aggregation Inhibitors
  • Tramadol
  • Clopidogrel
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Cytochrome P-450 CYP2D6