Economic analysis of pharmacogenomic-guided clopidogrel treatment in Serbian patients with myocardial infarction undergoing primary percutaneous coronary intervention

• Published in: Pharmacogenomics 2016-11, Vol.17 (16), p.1775-1784
• Main Authors: Mitropoulou, Christina, Fragoulakis, Vasilios, Rakicevic, Ljiljana B, Novkovic, Mirjana M, Vozikis, Athanassios, Matic, Dragan M, Antonijevic, Nebojsa M, Radojkovic, Dragica P, van Schaik, Ron H, Patrinos, George P
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Alleles; Angioplasty; Cardiac arrhythmia; Cardiology; Clopidogrel; Consortia; Developing countries; Economic analysis; economic evaluation; Electrocardiography; Genetic analysis; Genetic screening; Genotype & phenotype; Genotypes; Genotyping; Glycoproteins; Heart attacks; Hospitals; Hyperactivity; Ischemia; LDCs; Myocardial infarction; Patients; Pharmacoeconomics; Pharmacogenomics; Rehabilitation; Serbian population; Stroke; Studies; Task forces; Thrombosis
• ISSN: 1462-2416; 1744-8042
• DOI: 10.2217/pgs-2016-0052

Clopidogrel, which is activated by the CYP2C19 enzyme, is among the drugs for which all major regulatory agencies recommend genetic testing to be performed to identify a patient's genotype in order to determine the optimal antiplatelet therapeutic scheme. The and variants are loss-of-function alleles, leading to abolished CYP2C19 function and thus have the risk of thrombotic events for carriers of these alleles on standard dosages, while the allele results in CYP2C19 hyperactivity. Here, we report our findings from a retrospective study to assess whether genotyping for the allele was cost effective for myocardial infarction patients receiving clopidogrel treatment in the Serbian population compared with the nongenotype-guided treatment. We found that 59.3% of the patients had a minor or major bleeding event versus 42.85% of the and , while a reinfarction event occurred only in 2.3% of the patients, compared with 11.2% of the and patients. There were subtle differences between the two patient groups, as far as the duration of hospitalization and rehabilitation is concerned, in favor of the group. The mean cost for the patients was estimated at €2547 versus €2799 in the and patients. Furthermore, based on the overall genotype frequencies in the Serbian population, a break-even point analysis indicated that performing the genetic test prior to drug prescription represents a cost-saving option, saving €13 per person on average. Overall, our data demonstrate that pharmacogenomics-guided clopidogrel treatment may represent a cost-saving approach for the management of myocardial infarction patients undergoing primary percutaneous coronary intervention in Serbia.