CYP2C19 Genotype guided therapy of Acute Coronary Syndromes: a cost utility analysis
Dual antiplatelet therapy with aspirin and clopidogrel has proven to be the standard of care across the spectrum of acute coronary syndromes and for patients undergoing PCI with or without stenting (Mega et. al, 2008). However, approximately 15% of Caucasian population are carriers of CYP2C19 reduced function alleles and 3-4% have inactive enzyme function. These polymorphisms are strongly linked to reduced exposure to the active drug metabolite, less platelet inhibition, and less protection against recurrent ischemic events in patients treated with clopidogrel (Mega et. al, 2008).
Genotyping for CYP2C19 in patients who suffered from a cardiovascular disease, contributes to the creation of tailored therapies that effectively reduce the risk of major adverse events like recurrent heart attack, stroke or death. Initially, tailored treatments might drive costs up but in the long term, they might reduce overall societal and healthcare costs by avoiding adverse events treatment costs. In addition, patients’ quality of life could be improved by prescribing the correct dose of Clopidogrel or switching to a different antiplatelet drug. Consequently, therapy’s efficiency would increase, and life-threatening effects derived from reduced drug’s metabolism can be avoided.
The research question is: “in terms of benefits and costs is CYP2C19 genotyping an optimal addition to the current secondary treatment of ACS patients?”.
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