Economic analysis of pharmacogenomic-guided clopidogrel treatment in Serbian patients with myocardial infarction undergoing primary percutaneous coronary intervention

Introduction: Clopidogrel, which is activated by the CYP2C19 enzyme, is among the drugs for which all major regulatory agencies recommend genetic testing to be performed to identify a patient's CYP2C19 genotype in order to determine the optimal antiplatelet therapeutic scheme. The CYP2C19∗2 and CYP2C19∗3 variants are loss-of-function alleles, leading to abolished CYP2C19 function and thus have the risk of thrombotic events for carriers of these alleles on standard dosages, while the CYP2C19∗17 allele results in CYP2C19 hyperactivity. Aims: Here, we report our findings from a retrospective study to assess whether genotyping for the CYP2C19∗2 allele was cost effective for myocardial infarction patients receiving clopidogrel treatment in the Serbian population compared with the nongenotype-guided treatment. Results: We found that 59.3% of the CYP2C19∗1/∗1 patients had a minor or major bleeding event versus 42.85% of the CYP2C19∗1/∗2 and ∗2/∗2, while a reinfarction event occurred only in 2.3% of the CYP21C9∗1/∗1 patients, compared with 11.2% of the CYP2C19∗1/∗2 and CYP2C19∗2/∗2 patients. There were subtle differences between the two patient groups, as far as the duration of hospitalization and rehabilitation is concerned, in favor of the CYP2C19∗1/∗1 group. The mean cost for the CYP2C19∗1/∗1 patients was estimated at €2547 versus €2799 in the CYP2C19∗1/∗2 and CYP2C19∗2/∗2 patients. Furthermore, based on the overall CYP2C19∗1/∗2 genotype frequencies in the Serbian population, a break-even point analysis indicated that performing the genetic test prior to drug prescription represents a cost-saving option, saving €13 per person on average. Conclusion: Overall, our data demonstrate that pharmacogenomics-guided clopidogrel treatment may represent a cost-saving approach for the management of myocardial infarction patients undergoing primary percutaneous coronary intervention in Serbia.

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