Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis

Pharmacogenomics J. 2022 May;22(3):188-197. doi: 10.1038/s41397-022-00275-7. Epub 2022 Apr 1.


We constructed a cost-effectiveness model to assess the clinical and economic value of a CDS alert program that provides pharmacogenomic (PGx) testing results, compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF), from a health system perspective. We defaulted that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated over 20 years with an annual discount rate of 3%. In total, 3169 alerts would be fired. The CDS alert program would help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was $39,477/QALY. A PGx-CDS alert program was cost-effective, under a willingness-to-pay threshold of $100,000/QALY gained, compared to no alert program.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Coronary Syndrome* / drug therapy
  • Acute Coronary Syndrome* / genetics
  • Aged
  • Anticoagulants / adverse effects
  • Atrial Fibrillation* / drug therapy
  • Atrial Fibrillation* / genetics
  • Clopidogrel
  • Cost-Benefit Analysis
  • Decision Support Systems, Clinical*
  • Humans
  • Markov Chains
  • Middle Aged
  • Pharmacogenetics
  • Quality-Adjusted Life Years
  • Vitamin K Epoxide Reductases / genetics
  • Warfarin


  • Anticoagulants
  • Warfarin
  • Clopidogrel
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases