西班牙急性冠脉综合征患者参与 U-PGx PREPARE 研究的药物基因组指导抗血小板治疗的经济学评价。

Economic evaluation of pharmacogenomic-guided antiplatelet treatment in Spanish patients suffering from acute coronary syndrome participating in the U-PGx PREPARE study.

机构信息

Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece.

The Golden Helix Foundation, 91 Waterloo Road, Capital Tower 6th Floor, London, SE1 9RT, UK.

出版信息

Hum Genomics. 2023 Jun 7;17(1):51. doi: 10.1186/s40246-023-00495-3.

DOI:10.1186/s40246-023-00495-3

PMID:37287029

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10249170/

Abstract

BACKGROUND

Cardiovascular diseases and especially Acute Coronary Syndrome (ACS) constitute a major health issue impacting millions of patients worldwide. Being a leading cause of death and hospital admissions in many European countries including Spain, it accounts for enormous amounts of healthcare expenditures for its management. Clopidogrel is one of the oldest antiplatelet medications used as standard of care in ACS.

METHODS

In this study, we performed an economic evaluation study to estimate whether a genome-guided clopidogrel treatment is cost-effective compared to conventional one in a large cohort of 243 individuals of Spanish origin suffering from ACS and treated with clopidogrel. Data were derived from the U-PGx PREPARE clinical trial. Effectiveness was measured as survival of individuals while study data on safety and efficacy, as well as on resource utilization associated with each adverse drug reaction were used to measure costs to treat these adverse drug reactions. A generalized linear regression model was used to estimate cost differences for both study groups.

RESULTS

Based on our findings, PGx-guided treatment group is cost-effective. PGx-guided treatment demonstrated to have 50% less hospital admissions, reduced emergency visits and almost 13% less ADRs compared to the non-PGx approach with mean QALY 1.07 (95% CI, 1.04-1.10) versus 1.06 (95% CI, 1.03-1.09) for the control group, while life years for both groups were 1.24 (95% CI, 1.20-1.26) and 1.23 (95% CI, 1.19-1.26), respectively. The mean total cost of PGx-guided treatment was 50% less expensive than conventional therapy with clopidogrel [€883 (95% UI, €316-€1582), compared to €1,755 (95% UI, €765-€2949)].

CONCLUSION

These findings suggest that PGx-guided clopidogrel treatment represents a cost-effective option for patients suffering from ACS in the Spanish healthcare setting.

摘要

背景

心血管疾病，尤其是急性冠脉综合征（ACS），是全球数以百万计患者面临的主要健康问题。ACS 是包括西班牙在内的许多欧洲国家的主要死亡和住院原因，因此在管理方面需要投入大量的医疗保健支出。氯吡格雷是一种最古老的抗血小板药物，是 ACS 的标准治疗药物。

方法

在这项研究中，我们进行了一项经济评估研究，以评估在西班牙裔 ACS 患者的大型队列中，与传统治疗相比，基于基因组的氯吡格雷治疗是否具有成本效益。该队列共纳入了 243 名患者，他们接受了氯吡格雷治疗。研究数据来源于 U-PGx PREPARE 临床试验。生存是通过个体的生存来衡量的，而安全性和有效性研究数据以及与每种不良反应相关的资源利用情况则用于衡量治疗这些不良反应的成本。使用广义线性回归模型来估计两组研究的成本差异。

结果

根据我们的发现，PGx 指导治疗组具有成本效益。PGx 指导治疗组与非 PGx 组相比，住院率降低了 50%，急诊就诊率降低了近 13%，不良反应发生率降低了 50%，平均 QALY 为 1.07（95%CI，1.04-1.10），而对照组为 1.06（95%CI，1.03-1.09），两组的预期寿命均为 1.24（95%CI，1.20-1.26）和 1.23（95%CI，1.19-1.26）。PGx 指导治疗的平均总成本比传统氯吡格雷治疗低 50%[883 欧元（95%置信区间，316-1582 欧元），而氯吡格雷治疗为 1755 欧元（95%置信区间，765-2949 欧元）]。