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Article

A Cost–Consequence Analysis of Preemptive SLCO1B1 Testing for Statin Myopathy Risk Compared to Usual Care

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Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA
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Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC 27705, USA
3
Durham VA Health Care System, Durham, NC 27705, USA
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Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
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Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA 02115, USA
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Population Precision Health, Ariadne Labs, Boston, MA 02215, USA
7
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Latha Palaniappan, Sean P. David and Deepak Voora
J. Pers. Med. 2021, 11(11), 1123; https://doi.org/10.3390/jpm11111123
Received: 9 October 2021 / Revised: 27 October 2021 / Accepted: 29 October 2021 / Published: 31 October 2021
(This article belongs to the Special Issue Pharmacogenetic Testing in Primary Care and Prevention)
There is a well-validated association between SLCO1B1 (rs4149056) and statin-associated muscle symptoms (SAMS). Preemptive SLCO1B1 pharmacogenetic (PGx) testing may diminish the incidence of SAMS by identifying individuals with increased genetic risk before statin initiation. Despite its potential clinical application, the cost implications of SLCO1B1 testing are largely unknown. We conducted a cost–consequence analysis of preemptive SLCO1B1 testing (PGx+) versus usual care (PGx−) among Veteran patients enrolled in the Integrating Pharmacogenetics in Clinical Care (I-PICC) Study. The assessment was conducted using a health system perspective and 12-month time horizon. Incremental costs of SLCO1B1 testing and downstream medical care were estimated using data from the U.S. Department of Veterans Affairs’ Managerial Cost Accounting System. A decision analytic model was also developed to model 1-month cost and SAMS-related outcomes in a hypothetical cohort of 10,000 Veteran patients, where all patients were initiated on simvastatin. Over 12 months, 13.5% of PGx+ (26/193) and 11.2% of PGx− (24/215) participants in the I-PICC Study were prescribed Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline-concordant statins (Δ2.9%, 95% CI −4.0% to 10.0%). Differences in mean per-patient costs for lipid therapy prescriptions, including statins, for PGx+ compared to PGx− participants were not statistically significant (Δ USD 9.53, 95% CI −0.86 to 22.80 USD). Differences in per-patient costs attributable to the intervention, including PGx testing, lipid-lowering prescriptions, SAMS, laboratory and imaging expenses, and primary care and cardiology services, were also non-significant (Δ− USD 1004, 95% CI −2684 to 1009 USD). In the hypothetical cohort, SLCO1B1-informed statin therapy averted 109 myalgias and 3 myopathies at 1-month follow up. Fewer statin discontinuations (78 vs. 109) were also observed, but the SLCO1B1 testing strategy was 96 USD more costly per patient compared to no testing (124 vs. 28 USD). The implementation of SLCO1B1 testing resulted in small, non-significant increases in the proportion of patients receiving CPIC-concordant statin prescriptions within a real-world primary care context, diminished the incidence of SAMS, and reduced statin discontinuations in a hypothetical cohort of 10,000 patients. Despite these effects, SLCO1B1 testing administered as a standalone test did not result in lower per-patient health care costs at 1 month or over 1 year of treatment. The inclusion of SLCO1B1, among other well-validated pharmacogenes, into preemptive panel-based testing strategies may provide a better balance of clinical benefit and cost. View Full-Text
Keywords: SLCO1B1; statin-associated muscle symptoms; pharmacogenetics; cost–consequence analysis; cardiovascular disease; precision medicine SLCO1B1; statin-associated muscle symptoms; pharmacogenetics; cost–consequence analysis; cardiovascular disease; precision medicine
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MDPI and ACS Style

Brunette, C.A.; Dong, O.M.; Vassy, J.L.; Danowski, M.E.; Alexander, N.; Antwi, A.A.; Christensen, K.D. A Cost–Consequence Analysis of Preemptive SLCO1B1 Testing for Statin Myopathy Risk Compared to Usual Care. J. Pers. Med. 2021, 11, 1123. https://doi.org/10.3390/jpm11111123

AMA Style

Brunette CA, Dong OM, Vassy JL, Danowski ME, Alexander N, Antwi AA, Christensen KD. A Cost–Consequence Analysis of Preemptive SLCO1B1 Testing for Statin Myopathy Risk Compared to Usual Care. Journal of Personalized Medicine. 2021; 11(11):1123. https://doi.org/10.3390/jpm11111123

Chicago/Turabian Style

Brunette, Charles A., Olivia M. Dong, Jason L. Vassy, Morgan E. Danowski, Nicholas Alexander, Ashley A. Antwi, and Kurt D. Christensen. 2021. "A Cost–Consequence Analysis of Preemptive SLCO1B1 Testing for Statin Myopathy Risk Compared to Usual Care" Journal of Personalized Medicine 11, no. 11: 1123. https://doi.org/10.3390/jpm11111123

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