Wright Stuart, McDermott John, Sen Dwaipayan, Smith Craig, Newman William, Payne Katherine
Manchester Centre for Health Economics, The University of Manchester, Manchester, M139PL, UK.
Manchester Centre for Genomic Medicine, The University of Manchester, Manchester, M13 9PL, UK.
Wellcome Open Res. 2023 Apr 24;8:183. doi: 10.12688/wellcomeopenres.19202.1. eCollection 2023.
People who have experienced a stroke are at high risk of recurrent strokes. Clopidogrel is prescribed to people who have had a non-cardioembolic stroke. There is evidence that clopidogrel is not effective for patients with loss-of-function alleles. Pharmacogenetic testing is a potential strategy to identify such patients and guide prescription of appropriate antiplatelet treatment. This study aimed to provide an early estimate of the cost-effectiveness of using a point-of-care pharmacogenetic test in the UK National Health System. A decision-analytic model comprising a linked decision tree and Markov model were created in R comparing pharmacogenetic testing with current prescribing practice. In the pharmacogenetic testing arm, patients identified to have one of three loss-of-function alleles were prescribed modified-release dipyridamole and aspirin or aspirin alone. Indicative data were sourced from reviews of the literature supported by expert consultation to select the most appropriate value for the input parameters. The healthcare costs (£;2021) and quality adjusted life years resulting from each strategy were estimated and the incremental cost-effectiveness of testing calculated. Deterministic threshold analysis and probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the parameter estimates. The pharmacogenetic testing strategy generated 0.107 additional QALYs per patient tested and saved £512. Pharmacogenetic testing dominated current prescribing practice. The results were robust to extreme changes in key input variables. The PSA suggested that there was a 77% chance that pharmacogenetic testing would be cost-effective with a 62% chance it is cost-saving. A point-of-care pharmacogenetic test to guide prescription of clopidogrel for people who have experienced a stroke has the potential to provide a significant health gain by preventing secondary strokes and may save resources in the health system. This early economic analysis has also informed the direction for future research.
经历过中风的人再次中风的风险很高。氯吡格雷被开给患有非心源性栓塞性中风的人。有证据表明，氯吡格雷对功能缺失等位基因的患者无效。药物遗传学检测是识别此类患者并指导适当抗血小板治疗处方的潜在策略。本研究旨在对在英国国家医疗服务体系中使用即时检验药物遗传学检测的成本效益进行早期评估。在R语言中创建了一个由链接决策树和马尔可夫模型组成的决策分析模型，将药物遗传学检测与当前的处方实践进行比较。在药物遗传学检测组中，被确定有三种功能缺失等位基因之一的患者被开给缓释双嘧达莫和阿司匹林或仅开阿司匹林。指示性数据来自文献综述，并经专家咨询支持，以选择最合适的输入参数值。估计了每种策略产生的医疗保健成本（£；2021年）和质量调整生命年，并计算了检测的增量成本效益。进行了确定性阈值分析和概率敏感性分析（PSA），以考虑参数估计中的不确定性。药物遗传学检测策略为每位接受检测的患者额外产生了0.107个质量调整生命年，并节省了512英镑。药物遗传学检测优于当前的处方实践。结果对关键输入变量的极端变化具有稳健性。PSA表明，药物遗传学检测具有成本效益的概率为77%，节省成本的概率为62%。一种用于指导中风患者氯吡格雷处方的即时检验药物遗传学检测有可能通过预防二次中风带来显著的健康益处，并可能节省卫生系统的资源。这项早期经济分析也为未来的研究方向提供了参考。
