ECONOMIC EVALUATION OF CYP2C19 GENOTYPE-GUIDED ANTIPLATELET THERAPY FOR PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.17501/26138417.2026.9102Keywords:
coronary artery disease, percutaneous coronary intervention, CYP2C19 testing, clopidogrel, economic evaluation, systematic reviewAbstract
Dual antiplatelet therapy with clopidogrel is essential for patients undergoing percutaneous coronary intervention, but clopidogrel’s effectiveness varies due to CYP2C19 genetic differences. This is critical in Asian populations, where CYP2C19 loss-of-function alleles are nearly twice as prevalent as in Caucasians, increasing thrombotic risk. Alternatives such as ticagrelor and prasugrel are more effective, but costlier with higher bleeding risks, making CYP2C19 genotype-guided therapy a potentially efficient approach. This study updates systematic reviews of economic evaluations of CYP2C19 genotyping in coronary artery disease patients undergoing percutaneous coronary intervention to inform policy and clinical decisions. PubMed and Scopus were searched through October 2025 for full economic evaluations. Non-English or inaccessible full-text studies were excluded. Reporting and evidence quality were assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 Checklist and the Cooper hierarchy. Due to heterogeneity, results were synthesized narratively. Twenty-two studies from nine countries were included, with most conducted in high-income settings. Across extracted base-case comparisons, genotype-guided strategies were generally cost-effective or cost-saving when compared with universal clopidogrel or universal prasugrel, while results were less favorable when compared with universal ticagrelor. Key drivers of cost-effectiveness were drug prices, clinical event risks, and allele prevalence, whereas testing costs were less frequently influential. Evidence from lower-income countries was limited and results varied with local costs, testing availability, and treatment pathways. Overall, genotype-guided antiplatelet therapy appears economically favorable in many settings, but decisions should be context-specific, particularly in Asian settings with high CYP2C19 loss-of-function burden.
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Copyright (c) 2026 Chau H. Lam, Anh N. T. Vuong, Assoc.Prof. Dr. Usa Chaikledkaew, Asst. Prof. Dr. Saowalak Turongkaravee
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