The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.
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.
我们构建了一个成本效益模型，以评估从医疗体系的角度来看，为急性冠脉综合征（ACS）和心房颤动（AF）患者提供药物基因组学（PGx）检测结果的临床和经济价值的临床决策支持（CDS）警报程序相对于没有警报程序的情况。我们假设每年有 20%的 55 至 65 岁之间的 50 万医疗体系成员接受 CYP2C19（ACS-氯吡格雷）和 CYP2C9、CYP4F2 和 VKORC1（AF-华法林）的 PGx 检测。临床事件、成本和质量调整生命年（QALY）在 20 年内进行计算，年贴现率为 3%。总共会触发 3169 个警报。CDS 警报程序将有助于避免 16 例 ACS 重大临床事件和 6 例死亡；以及 2 例 AF 临床事件和 0.9 例死亡。增量成本效益比为每 QALY 39477 美元。与无警报程序相比，PGx-CDS 警报程序在愿意支付的 100,000 美元/QALY 收益阈值下具有成本效益。
