Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases.
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'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.
['Zhu|Ye|Y|', 'Swanson|Kristi M|KM|', 'Rojas|Ricardo L|RL|', 'Wang|Zhen|Z|', 'St Sauver|Jennifer L|JL|', 'Visscher|Sue L|SL|', 'Prokop|Larry J|LJ|', 'Bielinski|Suzette J|SJ|', 'Wang|Liewei|L|', 'Weinshilboum|Richard|R|', 'Borah|Bijan J|BJ|http://orcid.org/0000-0002-4526-462X']
D002318:Cardiovascular Diseases D000077144:Clopidogrel D003362:Cost-Benefit Analysis D065731:Cytochrome P-450 CYP2C19 D065729:Cytochrome P-450 CYP2C9 D006801:Humans D010597:Pharmacogenetics D000071185:Pharmacogenomic Testing D057285:Precision Medicine D064417:Vitamin K Epoxide Reductases D014859:Warfarin
cost-effectiveness cardiovascular disease pharmacogenomics economic evaluation disease management