【摘要】 目的:系统评价CYP2C19基因检测指导急性冠脉综合征患者抗血小板个体化治疗的药物经济学特性,为临床药物基因型合理检测及相关卫生决策提供参考。方法:计算机检索Pub Med、Embase、The Cochrane Library、Wan Fang Data、CNKI、VIP数据库关于CYP2C19基因型检测指导急性冠脉综合征患者抗血小板个体化治疗的药物经济学文献,检索时限均为建库至2018年5月。由两名研究者独立筛选文献、评价纳入研究的方法学质量,提取纳入研究的相关数据进行系统分析。结果:最终纳入13项研究,仅1篇为成本-效用分析,其余均为成本-效果分析,13项研究中2项来自中国。10项研究均显示基因检测指导个体化抗血小板治疗(其中有1项是基因检测联合血小板功能测定;但1项来自中国的研究显示若患者为自费或为上海市医保,经验性使用替格瑞洛更具经济学优势,而基因指导方案在全国范围的医保患者中更具药物经济学优势)更具成本效果优势。有3项研究表明经验性全部使用替格瑞洛(其中1项是药师参与药物治疗管理联合经验性使用替格瑞洛)更具成本效果优势。结论:CYP2C19基因型检测指导急性冠脉综合征患者抗血小板个体化治疗总体具有良好的经济学优势,但鉴于文献数量及质量限制,结论仍需更多高质量的经济学研究进一步支持。更多还原

【Abstract】 Objective: To systematically evaluate the pharmacoeconomic studies of CYP2C19 genotype detection in antiplatelet individualization therapy in patients with acute coronary syndrome,and provide references for rational genetic test and relevant health decisions. Methods: Pub Med,Embase,The Cochrane Library,CNKI,Wan Fang Data and VIP database were electronically searched to collect pharmacoeconomic on anti-platelet individualization therapy by CYP2C19 genotype detection in patients with acute coronary syndrome from inception to May 2018. Two researchers independently screened literature and assessed risk of bias of included studies,then relevant data was extracted for systematic analysis.Results: 13 studies were finally included,only one of which was cost-utility analysis,while the rest were cost-effectiveness studies. Two of the 13 studies were from China. 10 studies had shown that gene testing guiding individualized antiplatelet therapy. But in which a study from China had shown that experiential use of ticagrelor has an economic advantage if patients paid for their own care or were insured in Shanghai. 3 studies had shown that conventional use of ticagrelor( one of which was the combination of pharmacologist participation in Medication Therapy Management and experiential use of ticagrelor)was more cost-effective. Conclusion: As a whole,CYP2C19 genotype detection had a good economic advantage in guiding the individualized treatment of antiplatelet in patients with acute coronary syndrome. However,in view of the limitation quantity and quality of literature included,more high-quality economic research was still needed to support the conclusion in the future.更多还原