Cost-Effectiveness of Pharmacogenomics-Guided Treatment in Cardiovascular Disease: An Umbrella Review.

Genotype-guided cardiovascular prescribing — CYP2C19 for clopidogrel, CYP2C9/VKORC1 for coumarins, SLCO1B1 for statins — is assessed here on cost-effectiveness rather than on clinical effect.

This systematic review of systematic reviews, pre-registered in PROSPERO (CRD420261281565) and based on five databases searched from inception without language restriction, brings together ten systematic reviews published between 2010 and 2024, encompassing 149 unique primary cost-effectiveness studies. Overlap across reviews was moderate (corrected covered area 9.47%) and most evidence came from economic modelling, with substantial heterogeneity across drug-gene pairs, comparators and healthcare settings. CYP2C19-guided clopidogrel was frequently reported as cost-effective or cost-saving, although results were less favourable when universal ticagrelor served as the comparator. Evidence for CYP2C9/VKORC1-guided coumarin anticoagulation was more heterogeneous, and data on SLCO1B1-guided statin therapy were too sparse to conclude. No review reported pooled incremental cost-effectiveness ratios or net monetary benefit; risk of bias was low in 7 reviews and AMSTAR 2 confidence was high in 4 of 10.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The useful message is not that cardiovascular pharmacogenomics pays off, but that it does so very unevenly depending on the drug-gene pair and above all on the comparator: the one pair that holds up, CYP2C19-clopidogrel, loses its advantage against universal ticagrelor. That none of the ten reviews could produce a pooled cost-effectiveness ratio says enough about a field still built on stacked models rather than real-world data. Read it as a status report to argue for reimbursement, not as proof of efficiency.

Analysis by Dr Thibaut Benquey