Cost-effectiveness of CYP2C19 genotyping to guide antiplatelet therapy for acute minor stroke and high-risk transient ischemic attack.
Cost-effectiveness of CYP2C19 genotyping to guide antiplatelet therapy for acute minor stroke and high-risk transient ischemic attack.
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CYP2C19 基因分型指导急性轻微卒中和高危短暂性脑缺血发作抗血小板治疗的成本效益
DOI：
10.1038/s41598-021-86824-9
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发表时间：
2021-04-01
影响因子：
4.6
通讯作者：
Wu Z
中科院分区：
文献类型：
--
作者：
Cai Z;Cai D;Wang R;Wang H;Yu Z;Gao F;Liu Y;Kang Y;Wu Z
在急性轻度卒中和短暂性脑缺血发作(TIA)后48小时内联合应用氯吡格雷和阿司匹林的双重抗血小板治疗(DAPT)可有效降低卒中复发的发生率。然而，细胞色素P450 2C19(细胞色素P450 2C19)基因多态性已被证明影响氯吡格雷的疗效。携带低复发风险(ESRS <； 3)的功能丧失等位基因(LoFA)的患者根本无法从氯吡格雷加阿司匹林中受益，并且可能会增加出血风险。为了优化这些患者的抗血小板治疗，避免医疗资源的浪费，通过CYP2C19基因分型，确定氯吡格雷联合阿司匹林治疗DAPT真正受益的亚组是很重要的。本研究旨在评估CYP2C19基因分型用于指导中国患者急性轻度卒中或高危TIA药物治疗的成本-效果。构建决策树和马尔可夫模型，对CYP2C19基因分型的成本-效果进行评价。我们采用了医疗保健支付者的观点，主要结果包括质量调整寿命年(QALY)、成本和增量成本-效果比(ICER)。进行了敏感性分析以评估结果的稳健性。CYP2C19基因分型以420.13元(59.85美元)的额外成本导致0.031个QALY的寿命增加，每增加一个QALY产生的ICER为13552.74元(1930.59美元)。概率敏感度分析表明，在95.7%的模拟中，基因测试在每QALY 72,100元(人均GDP 10,300美元)的支付意愿门槛下更具成本效益。因此，对中国来说，用CYP2C19基因分型来指导急性轻度卒中和高危TIA的抗血小板治疗是非常划算的。
Dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin within 48 h of acute minor strokes and transient ischemic attacks (TIAs) has been indicated to effectively reduce the rate of recurrent strokes. However, the efficacy of clopidogrel has been shown to be affected by cytochrome P450 2C19 (CYP2C19) polymorphisms. Patients carrying loss-of-function alleles (LoFAs) at a low risk of recurrence (ESRS < 3) cannot benefit from clopidogrel plus aspirin at all and may have an increased bleeding risk. In order to optimize antiplatelet therapy for these patients and avoid the waste of medical resources, it is important to identify the subgroups that genuinely benefit from DAPT with clopidogrel plus aspirin through CYP2C19 genotyping. This study sought to assess the cost-effectiveness of CYP2C19 genotyping to guide drug therapy for acute minor strokes or high-risk TIAs in China. A decision tree and Markov model were constructed to evaluate the cost-effectiveness of CYP2C19 genotyping. We used a healthcare payer perspective, and the primary outcomes included quality-adjusted life years (QALYs), costs and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to evaluate the robustness of the results. CYP2C19 genotyping resulted in a lifetime gain of 0.031 QALYs at an additional cost of CNY 420.13 (US$ 59.85), yielding an ICER of CNY 13,552.74 (US$ 1930.59) per QALY gained. Probabilistic sensitivity analysis showed that genetic testing was more cost-effective in 95.7% of the simulations at the willingness-to-pay threshold of CNY 72,100 (GDP per capita, US$ 10,300) per QALY. Therefore, CYP2C19 genotyping to guide antiplatelet therapy for acute minor strokes and high-risk TIAs is highly cost-effective in China.
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影响因子：
20.3
作者：
Hulot, Jean-Sebastien;Bura, Alessandra;Gaussem, Pascale
通讯作者：
Gaussem, Pascale
影响因子：
2.8
作者：
Barlas, Raphae S.;Loke, Yoon K.;Myint, Phyo K.
通讯作者：
Myint, Phyo K.
影响因子：
10.4
作者：
Sibbing, D.;Gebhard, D.;Kastrati, A.
通讯作者：
Kastrati, A.
氯吡格雷治疗中风的疗效取决于 CYP2C19 基因型和风险状况。
影响因子：
11.2
作者：
Xu, Jie;Wang, Anxin;Wang, Yongjun
通讯作者：
Wang, Yongjun
二级中风预防中的抗血小板治疗——最先进的。
影响因子：
5.3
作者：
Diener HC;Weimar C;Weber R
通讯作者：
Weber R