A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induce
- PDF / 700,450 Bytes
- 14 Pages / 595.276 x 790.866 pts Page_size
- 69 Downloads / 139 Views
ORIGINAL RESEARCH ARTICLE
A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induced Myopathy in Patients Initiating a Statin in Secondary Cardiovascular Prevention Dominic Mitchell1,2 • Jason R. Guertin3,4 • Anick Dubois1,5,6 • Marie-Pierre Dube´1,5,6 Jean-Claude Tardif1,5,6 • Ange Christelle Iliza1,2 • Fiorella Fanton-Aita1,2 • Alexis Matteau1,2,7 • Jacques LeLorier1,2
•
Ó Springer International Publishing AG, part of Springer Nature 2018
Abstract Background Statin (HMG-CoA reductase inhibitor) therapy is the mainstay dyslipidemia treatment and reduces the risk of a cardiovascular (CV) event (CVE) by up to 35%. However, adherence to statin therapy is poor. One reason patients discontinue statin therapy is musculoskeletal pain and the associated risk of rhabdomyolysis. Research is ongoing to develop a pharmacogenomics (PGx) test for statin-induced myopathy as an alternative to the current diagnosis method, which relies on creatine kinase levels. The potential economic value of a PGx test for statin-induced myopathy is unknown. Methods We developed a lifetime discrete event simulation (DES) model for patients 65 years of age initiating a statin after a first CVE consisting of either an acute Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40291-018-0323-2) contains supplementary material, which is available to authorized users. & Jacques LeLorier [email protected] 1
Faculte´ de Me´decine, Universite´ de Montre´al, Montre´al, QC, Canada
2
Centre de Recherche du Centre Hospitalier de l’Universite´ de Montre´al, 850 rue St-Denis, Montre´al, QC H2X 0A9, Canada
3
De´partement de Me´decine Sociale et Pre´ventive, Faculte´ de Me´decine, Universite´ Laval, Que´bec City, QC, Canada
4
Centre de Recherche du CHU de Que´bec, Universite´ Laval, Que´bec City, QC, Canada
5
Institut de Cardiologie de Montre´al, Montre´al, QC, Canada
6
Centre de Pharmacoge´nomique Beaulieu-Saucier de l’Universite´ de Montre´al, Montre´al, QC, Canada
7
Cardiology Division, Centre Hospitalier de l’Universite´ de Montre´al, Montre´al, QC, Canada
myocardial infarction (AMI) or a stroke. The model evaluates the potential economic value of a hypothetical PGx test for diagnosing statin-induced myopathy. We have assessed the model over the spectrum of test sensitivity and specificity parameters. Results Our model showed that a strategy with a perfect PGx test had an incremental cost-utility ratio of 4273 Canadian dollars ($Can) per quality-adjusted life year (QALY). The probabilistic sensitivity analysis shows that when the payer willingness-to-pay per QALY reaches $Can12,000, the PGx strategy is favored in 90% of the model simulations. Conclusion We found that a strategy favoring patients staying on statin therapy is cost effective even if patients maintained on statin are at risk of rhabdomyolysis. Our results are explained by the fact that statins are highly effective in reducing the CV risk in patients at high CV
Data Loading...
