Cost‐effectiveness analysis of CYP2C19 genotype‐guided antiplatelet therapy for patients with acute minor ischemic stroke and high‐risk transient ischemic attack in China

Aims The study aimed to estimate the cost‐effectiveness of CYP2C19 genotype‐guided antiplatelet therapy using cilostazol and ticagrelor as an alternative to clopidogrel, compared to conventional antiplatelet therapy with clopidogrel and aspirin. Methods A 90‐day decision tree and 30‐year Markov model were employed to assess the costs and quality‐adjusted life years (QALYs) of personalized antiplatelet therapy for patients with minor ischemic stroke and high‐risk transient ischemic attack, compared to conventional antiplatelet therapy in the Chinese healthcare system. The primary outcome was the incremental cost‐effectiveness ratio (ICER). The data sources included clinical trials, published literature, official documents and local prices. One‐way sensitivity analysis and probabilistic sensitivity analysis were performed to confirm the robustness of the findings. Results The base‐case analysis indicated that the CYP2C19 genotype‐guided antiplatelet strategy was cost‐effective, and cilostazol group and ticagrelor group yielded an ICER of 3327.40 US dollars (USD)/QALY and 3426.92 USD/QALY, respectively, which were less than threshold. The one‐way sensitivity analysis showed the results were robust, where the most sensitive parameter was the disability distribution in the modified Rankin scale 3‐5. The probabilistic analysis showed that the CYP2C19 genotype‐guided antiplatelet therapy with either cilostazol or ticagrelor was 100% cost‐effective under the willingness‐to‐pay threshold. Conclusions CYP2C19 genotype‐guided antiplatelet therapy using cilostazol and ticagrelor as an alternative to clopidogrel appeared to be more cost‐effective than conventional antiplatelet therapy for acute minor ischemic stroke and high‐risk transient ischemic attack patients over 30 years in China.