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- 2018
CYP2C19基因检测指导抗血小板治疗的成本-效果分析
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Abstract:
摘要：目的 评价CYP2C19基因检测指导中国急性冠脉综合征患者抗血小板治疗的有效性与经济性。方法 使用经济学评价专业分析软件TreeAge Pro 2012构建决策树及Markov模型，采用我国相关数据，比较基因检测指导抗血小板治疗与传统治疗的成本及效果。结果 当意愿支付阈值为三倍我国国内生产总值时，基因检测方案和替格瑞洛方案比直接使用氯吡格雷更有优势，且替格瑞洛方案比基因检测方案更具有成本-效果。结论 对于中国急性冠脉综合征患者而言，最具有成本效用的抗血小板方案是直接使用新一代抗血小板药物替格瑞洛，其次是药物基因组学检测指导的个体化治疗。
ABSTRACT: Objective To evaluate the effectiveness and economics of CYP2C19 genetic test in guiding antiplatelet therapy for Chinese patients with acute coronary syndromes. Methods The decision tree and Markov model were established using TreeAge Pro 2012 software, which simulated the costs and effectiveness of CYP2C19-guided antiplatelet therapy versus the traditional use of clopidogrel or ticagrelor from the perspective of China third-party payer. Results Base-case results showed that genotype-guided ticagrelor and universal ticagrelor were dominant compared with universal clopidogrel (incremental cost-effectiveness ratio underwillingness-to-pay threshold of three times China’s GDP). Universal ticagrelor was cost-effective when compared with universal clopidogrel. Conclusion The most cost-effective antiplatelet regimen for acute coronary syndromes patients in China is universal ticagrelor, followed by genotype-directed individualized therapy
| [1] | NIKOLIC E, JANZON M, HAUCH O, et al. Cost-effectiveness of treating acute coronary syndrome patients with ticagrelor for 12 months: Results from the PLATO study[J]. Eur Heart J, 2013, 34(3):220-228. |
| [2] | 钟诗龙，韩雅玲，陈纪言，等. 氯吡格雷抗血小板治疗个体化用药基因型检测指南解读[J]. 中国实用内科杂志, 2015, 35(1):38-41. |
| [3] | SORICH MJ, HOROWITZ JD, SORICH W, et al. Cost-effectiveness of using CYP2C19 genotype to guide selection of clopidogrel or ticagrelor in Australia[J]. Pharmacogenomics, 2013, 14(16):2013-2021. |
| [4] | KAZI DS, OWENS DK, HLATKY MA. Cost-effectiveness of genotype-guided and dual antiplatelet therapies RESPONSE[J]. Ann Intern Med, 2014, 161(5):378-379. |
| [5] | JIANG MH, YOU JHS. CYP2C19 genotype plus platelet reactivity-guided antiplatelet therapy in acute coronary syndrome patients: A decision analysis[J]. Pharmacogenet Genom, 2015, 25(12):609-617. |
| [6] | JIANG MH, YOU J. Personalized antiplatelet therapy by CYP2C19 loss-of-function and gain-of-function alleles ―a decision analysis[J]. Pharmacotherapy, 2016, 36(12):E263-E263. |
| [7] | JIANG MH, YOU JHS. Cost-effectiveness analysis of personalized antiplatelet therapy in patients with acute coronary syndrome[J]. Pharmacogenomics, 2016, 17(7):701-713. |
| [8] | MEGA JL, CLOSE SL, WIVIOTT SD, et al. Cytochrome P-450 polymorphisms and response to clopidogrel[J]. New Engl J Med, 2009, 360(4):354-362. |
| [9] | 沈迎，张瑞岩，沈卫峰. 冠心病患者双联抗血小板治疗策略进展――ACC/AHA冠心病患者双联抗血小板治疗指南更新解读[J].心脑血管病防治, 2016, (03):169-170+173. |
| [10] | WALLENTIN L, JAMES S, STOREY RF, et al. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: A genetic substudy of the PLATO trial[J]. Lancet, 2010, 376(9749):1320-1328. |
| [11] | 《中国药物经济学评价指南》课题组. 《中国药物经济学评价指南》[M]. 北京：北京大学中国卫生经济研究中心, 2011. |
| [12] | GURBEL PA, BLIDEN KP, HIATT BL, et al. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity[J]. Circulation, 2003, 107(23):2908-2913. |
| [13] | SEREBRUANY VL, STEINHUBL SR, BERGER PB, et al. Variability in platelet responsiveness to clopidogrel among 544 individuals[J]. J Am Coll Cardiol, 2005, 45(2):246-251. |
| [14] | CANNON CP, HUSTED S, HARRINGTON RA , et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: Primary results of the DISPERSE-2 trial[J]. J Am Coll Cardiol, 2007, 50(19):1844-1851. |
| [15] | GURBEL PA, BLIDEN KP, BUTLER K, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: The ONSET/OFFSET study[J]. Circulation, 2009, 120(25):2577-2585. |
| [16] | SCOTT SA, SANGKUHL K, STEIN CM , et al. Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C19 genotype and clopidogrel therapy: 2013 update[J]. Clin Pharmacol Ther, 2013, 94(3):317-323. |
| [17] | WALLENTIN L, BECKER RC, BUDAJ A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J]. New Engl J Med, 2009, 361(11):1045-1057. |
| [18] | KANG HJ, CLARE RM, GAO R, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the platelet inhibition and patient outcomes (PLATO) trial[J]. Am Heart J, 2015, 169(6):899-905 e891. |
| [19] | JANZON M, JAMES S, CANNON CP, et al. Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy[J].Heart, 2015, 101(2):119-125. |
| [20] | HOLMES MV, PEREL P, SHAH T, et al. CYP2C19 genotype, clopidogrel metabolism, platelet function, and cardiovascular events: A systematic review and meta-analysis[J]. JAMA, 2011, 306(24):2704-2714. |
| [21] | CRESPIN DJ, FEDERSPIEL JJ, BIDDLE AK, et al. Ticagrelor versus genotype-driven antiplatelet therapy for secondary prevention after acute coronary syndrome: A cost-effectiveness analysis[J]. Value Health, 2011, 14(4):483-491. |
