Sawsan AlMukdad, Hazem Elewa, Daoud Al-Badriyeh College of Pharmacy, QU Health, Qatar University, Doha, Qatar Background Objectives Methods Methods … continued Conclusion Results • Patients having CYP2C19*2 and *3 loss-of- function alleles and receiving clopidogrel are at higher risk of adverse cardiovascular outcomes • Ticagrelor is a more effective and expensive antiplatelet that is unaffected by the CYP2C19 polymorphism • Genotype-guided antiplatelet therapy (GGAT) allows the identification of CYP2C19*2 and *3 carrier status which can help guide the selection between ticagrelor and clopidogrel • To date, there are no economic evaluations that compares GGAT to universal use ticagrelor or clopidogrel after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in Qatar • The current study sought to comprehensively assess the utilization cost of CYP2C19 genotype-guided antiplatelet therapy, universal use of clopidogrel, and ticagrelor against their outcomes as first-line therapies in patients with ACS who underwent PCI in Qatar • Design • One-year decision-analytic simulation model (Fig. 1) and lifetime Markov model (Fig. 2) • This was based on a multivariate analysis, using Monte Carlo simulation • Data source • The probabilities of the clinical outcomes and utility values were obtained from recent meta analysis and sub-studies of the PLATO trial 1-4 • Mutation prevalence was derived from a local observational study • Cost calculations • Cost of resources, in Qatari Riyal (QAR, 2019/20), was obtained from the hospital perspective of Hamad Medical Corporation • Outcome measures • Incremental cost-effectiveness ratios (ICERs) • incremental cost-utility ratios (ICURs) • Sensitivity analyses • One-way and multivariate analyses were conducted Figure 1. One-year economic decision-analytic model of the antiplatelet strategies Figure 2. Long-term Markov model * Follow up model pathways are as above ACS: Acute coronary syndrome; PCI: Percutaneous coronary intervention; LOF: loss-of-function; D/C: Discontinuation • Events: myocardial infraction, stroke, stent thrombosis, cardiovascular death • Adverse drug reactions: major bleeding, dyspnoea Economic Evaluation of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to Universal Use of Ticagrelor or Clopidogrel in Qatar Graduate Student, Medical, Biomedical and Health Sciences • Based on the current economic evaluations in the literature, implementing CYP2C19 genotype-guided therapy is a cost-effective approach in guiding the selection of medication in patients with ACS post-PCI GGAT versus universal ticagrelor In the one-year model: GGAT was dominant in 60% of cases with the mean cost-saving of QAR 1511 In the Markov model: GGAT was cost-effective in 96% of cases, with a mean ICUR of 5,036 per QALY GGAT versus universal clopidogrel In the one-year model: GGAT was cost-effective in 85% of cases with a mean ICER of 22,216 per case of success In the Markov model: GGAT was dominant in 100% of the cases with a mean cost-saving of QAR 1,813 Universal clopidogrel versus universal ticagrelor In the one-year: Universal clopidogrel was dominant in 63% of cases with the mean cost-saving of QAR 2,137 In the Markov model: Universal clopidogrel was cost-effective in 99% of cases with a mean ICER of 38,650 per case of success • Sensitivity analyses • The model outcomes are robust, whereby, the superiority of an antiplatelet strategy versus another was not sensitive to any uncertainty This research is supported by GSRA award# GSRA5-2-0521-18060 from Qatar National Research Fund (a member of Qatar Foundation) Acknowledgment References 1. Fan ZG, et al. Comparisons between ticagrelor and clopidogrel following percutaneous coronary intervention in patients with acute coronary syndrome: a comprehensive meta-analysis. Drug Des Devel Ther 2019;13:719-30. 2. Cannon CP, et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet 2010;375:283-93. 3. Wallentin L, 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. Lancet 2010;376:1320-8. 4. Ali Z BL, et al. The impact of CYP2C19 genetic mutation and non-genetic factors on the incidence of major adverse cardiovascular events in patients treated with clopidogrel in Qatar. J Thromb Thrombolysis 2019;74:609