PMID- 14615467
OWN - NLM
STAT- MEDLINE
DCOM- 20040412
LR  - 20211203
IS  - 0091-2700 (Print)
IS  - 0091-2700 (Linking)
VI  - 43
IP  - 12
DP  - 2003 Dec
TI  - Polymorphisms and the pocketbook: the cost-effectiveness of cytochrome P450 2C19 
      genotyping in the eradication of Helicobacter pylori infection associated with 
      duodenal ulcer.
PG  - 1316-23
AB  - The clinical outcome of duodenal ulcer treated with proton pump inhibitor 
      (PPI)-based, anti-Helicobacter pylori (H.p.) regimens varies according to 
      cytochrome P450 2C19 (CYP2C19) genotype. CYP2C19 genotypes differ markedly in 
      peoples of Pacific Rim descent compared with another ethnicity. The authors 
      sought to determine the specific impact that these factors have on the 
      cost-effectiveness of duodenal ulcer management. Their model consisted of two 
      patient cohorts with Helicobacter pylori and duodenal ulcer, trichotomized into 
      CYP2C19 homozygous extensive metabolizers (EMs), heterozygous EMs, and poor 
      metabolizers (PMs), altering the anti-H.p. regimen in the genotyped cohort only. 
      The authors took the perspective of a third-party payer, and the denominator was 
      ulcer episode prevented. In the reference case, the use of CYP2C19 genotyping 
      prior to initiating anti-H.p. therapy was dominant (costs were saved with each 
      ulcer episode prevented) in all geographic regions of the United States. The 
      subsequent break-even analysis showed a range of 89.20 dollars to 118.96 
      dollars--from Hawaii to the Midwest, respectively--required to eliminate the 
      cost-savings from each genotype test performed. Using probabilities most 
      unfavorable to genotyping, the variation of peoples with Pacific Rim origins from 
      0% to 100% altered the cost-effectiveness from 495 dollars to 2125 dollars per 
      ulcer event prevented, respectively. The results suggest that treatment decisions 
      for H.p. infection that are based on a patient's CYP2C19 genotype decreases 
      expenses for health plans implementing testing. This analysis provides an 
      economic basis to support recent calls to expand this technology into routine 
      clinical care to prevent toxicity of narrow therapeutic index drugs.
FAU - Lehmann, David F
AU  - Lehmann DF
AD  - SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
FAU - Medicis, Joseph J
AU  - Medicis JJ
FAU - Franklin, Patricia D
AU  - Franklin PD
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Clin Pharmacol
JT  - Journal of clinical pharmacology
JID - 0366372
RN  - 0 (Proton Pump Inhibitors)
RN  - EC 1.- (Mixed Function Oxygenases)
RN  - EC 1.14.14.1 (Aryl Hydrocarbon Hydroxylases)
RN  - EC 1.14.14.1 (CYP2C19 protein, human)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP2C19)
SB  - IM
MH  - Aryl Hydrocarbon Hydroxylases/*genetics
MH  - Cost-Benefit Analysis
MH  - Cytochrome P-450 CYP2C19
MH  - Decision Support Techniques
MH  - Duodenal Ulcer/complications/*drug therapy/economics
MH  - Genotype
MH  - Helicobacter Infections/complications/*drug therapy
MH  - *Helicobacter pylori
MH  - Humans
MH  - Mixed Function Oxygenases/*genetics
MH  - Models, Economic
MH  - *Pharmacogenetics
MH  - Polymorphism, Genetic
MH  - Probability
MH  - *Proton Pump Inhibitors
MH  - Racial Groups
EDAT- 2003/11/15 05:00
MHDA- 2004/04/13 05:00
CRDT- 2003/11/15 05:00
PHST- 2003/11/15 05:00 [pubmed]
PHST- 2004/04/13 05:00 [medline]
PHST- 2003/11/15 05:00 [entrez]
AID - 43/12/1316 [pii]
AID - 10.1177/0091270003259389 [doi]
PST - ppublish
SO  - J Clin Pharmacol. 2003 Dec;43(12):1316-23. doi: 10.1177/0091270003259389.