Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis

IF 2.9 3区医学 Q2 GENETICS & HEREDITY

Pharmacogenomics Journal Pub Date : 2022-04-01 DOI:10.1038/s41397-022-00275-7

Shangqing Jiang, Patrick C. Mathias, Nathaniel Hendrix, Brian H. Shirts, Peter Tarczy-Hornoch, David Veenstra, Daniel Malone, Beth Devine

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引用次数: 1

Abstract

We constructed a cost-effectiveness model to assess the clinical and economic value of a CDS alert program that provides pharmacogenomic (PGx) testing results, compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF), from a health system perspective. We defaulted that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated over 20 years with an annual discount rate of 3%. In total, 3169 alerts would be fired. The CDS alert program would help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was $39,477/QALY. A PGx-CDS alert program was cost-effective, under a willingness-to-pay threshold of $100,000/QALY gained, compared to no alert program.

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实施药物基因组临床决策支持卫生系统:成本效用分析

从卫生系统的角度来看，我们构建了一个成本效益模型，以评估提供药物基因组学(PGx)检测结果的CDS警报程序与不提供急性冠状动脉综合征(ACS)和心房颤动(AF)警报程序的临床和经济价值。我们假设年龄在55岁到65岁之间的50万健康系统成员中有20%每年接受CYP2C19 (acs -氯吡格雷)和CYP2C9、CYP4F2和VKORC1 (af -华法林)的PGx检测。临床事件、成本和质量调整生命年(QALYs)以每年3%的贴现率计算20年。总共将触发3169个警报。CDS警报程序将有助于避免16个主要临床事件和6例ACS死亡;2例临床事件和0.9例房颤死亡。增量成本-效果比为39,477美元/QALY。与没有预警计划相比，PGx-CDS预警计划在10万美元/QALY的支付意愿阈值下具有成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacogenomics Journal 医学-药学

CiteScore

7.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The Pharmacogenomics Journal is a print and electronic journal, which is dedicated to the rapid publication of original research on pharmacogenomics and its clinical applications. Key areas of coverage include: Personalized medicine Effects of genetic variability on drug toxicity and efficacy Identification and functional characterization of polymorphisms relevant to drug action Pharmacodynamic and pharmacokinetic variations and drug efficacy Integration of new developments in the genome project and proteomics into clinical medicine, pharmacology, and therapeutics Clinical applications of genomic science Identification of novel genomic targets for drug development Potential benefits of pharmacogenomics.