TY - JOUR
T1 - Implementation of pharmacogenomic clinical decision support for health systems
T2 - a cost-utility analysis
AU - Jiang, Shangqing
AU - Mathias, Patrick C.
AU - Hendrix, Nathaniel
AU - Shirts, Brian H.
AU - Tarczy-Hornoch, Peter
AU - Veenstra, David
AU - Malone, Daniel
AU - Devine, Beth
N1 - Funding Information:
This project was funded by Agency for Healthcare Research and Quality (AHRQ) R21-HS26544.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85127542716&partnerID=8YFLogxK
U2 - 10.1038/s41397-022-00275-7
DO - 10.1038/s41397-022-00275-7
M3 - Article
C2 - 35365779
SN - 1470-269X
VL - 22
SP - 188
EP - 197
JO - Pharmacogenomics Journal
JF - Pharmacogenomics Journal
IS - 3
ER -