@article{b8a69c30c96d4ed3b9c7be5cb20a3d82,
title = "Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases",
abstract = "Purpose: To examine the evidence on the cost-effectiveness of implementing pharmacogenomics (PGx) in cardiovascular disease (CVD) care. Methods: We conducted a systematic review using multiple databases from inception to 2018. The titles and abstracts of cost-effectiveness studies on PGx-guided treatment in CVD care were screened, and full texts were extracted. Results: We screened 909 studies and included 46 to synthesize. Acute coronary syndrome and atrial fibrillation were the predominantly studied conditions (59%). Most studies (78%) examined warfarin–CYP2C9/VKORC1 or clopidogrel–CYP2C19. A payer{\textquoteright}s perspective was commonly used (39%) for cost calculations, and most studies (46%) were US-based. The majority (67%) of the studies found PGx testing to be cost-effective in CVD care, but cost-effectiveness varied across drugs and conditions. Two studies examined PGx panel testing, of which one examined pre-emptive testing strategies. Conclusion: We found mixed evidence on the cost-effectiveness of PGx in CVD care. Supportive evidence exists for clopidogrel–CYP2C19 and warfarin–CYP2C9/VKORC1, but evidence is limited in other drug–gene combinations. Gaps persist, including unclear explanation of perspective and cost inputs, underreporting of study design elements critical to economic evaluations, and limited examination of PGx panel and pre-emptive testing for their cost-effectiveness. This review identifies the need for further research on economic evaluations of PGx implementation.",
keywords = "cardiovascular disease, cost-effectiveness, disease management, economic evaluation, pharmacogenomics",
author = "Ye Zhu and Swanson, {Kristi M.} and Rojas, {Ricardo L.} and Zhen Wang and {St. Sauver}, {Jennifer L.} and Visscher, {Sue L.} and Prokop, {Larry J.} and Bielinski, {Suzette J.} and Liewei Wang and Richard Weinshilboum and Borah, {Bijan J.}",
note = "Funding Information: Year 2004–2008 2009–2013 2014–2018 Countrya United States Netherlands Canada Australia Other countries/regionsb No statement Disease diagnosis or indication Acute coronary syndrome (ACS) Atrial fibrillation (AF) Other diseases/patient subgroupsc No statement Drug category (associated genes) P2Y12 inhibitors (CYP2C19) Antithrombotic (CYP2C9, VKORC1) ACEIs (MME, XPNPEP2) Statin (and ezetimibe) (KIF6, Taq1B) Drug panels Othersd Testing timing After treatment plan made After treatment started Pre-emptive No statement Funding support Public Nonprofit organization (NPO) Private Combinationse None No statement Study strategies Cohort type Hypothetical Observational Randomized controlled trial Perspective Payerf Health-care provider Societal Health-care system No statement Time horizon Lifetime ≥20 years 3–10 years ≤3 years Othersg No statement Type of analysis Cost–utility analysis Cost–benefit analysis Othersh Patient age range ≥60 years old <60 years old Not specified Funding Information: The value of pharmacogenomics has not been unequivocally established, particularly surrounding pre-emptive and panel testing approaches. Standardized modeling approaches and high-quality reporting are needed. This research was partially supported by a research grant from Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and Mayo Clinic Center for Individualized Medicine. The authors affirm that this paper is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. The views expressed in the article are those of the authors and do not necessarily reflect the views of Mayo Clinic. Publisher Copyright: {\textcopyright} 2019, The Author(s).",
year = "2020",
month = mar,
day = "1",
doi = "10.1038/s41436-019-0667-y",
language = "English (US)",
volume = "22",
pages = "475--486",
journal = "Genetics in Medicine",
issn = "1098-3600",
publisher = "Lippincott Williams and Wilkins",
number = "3",
}