Application of personalized medicine to chronic disease: a feasibility assessment

Clinical and Translational Medicine

Table 2 Cost comparisons of current standard of care for stroke patients at BPH compared with pharmacogenetic stratification (PGx) or a randomized alternative

Proportion of stroke patients treated with particular medication	Average annual cost $	Base case (standard of care)	PGx stratified	Alternative random
ASA	27	0.5	0.5	0.5
Plavix	941	0.4	0.32	0.2
Aggrenox	601	0.1	0.1	0.1
Effient (estimated cost)	1110	0	0.08	0.2
Proportion of untreated		0.08	0.016	0.04
Recurrence risk untreated		0.2	0.2	0.2
Recurrence risk treated		0.072	0.072	0.072
Cost of treatment failure		53,576	53,576	53,576
Probability of failure		0.082	0.074	0.077
Risk adjusted failure cost^*		4406	3967	4132
Incremental annual cost of treatment		450	463	484
Cost of PGx test		0	250	0
Total costs Year 1		4856	4680	4615
Discounted costs Year 2^**		4714	4301	4481
Discounted costs Year 3^**		4577	4176	4350
Discounted costs Year 4^**		4444	4055	4224
Discounted costs Year 5^**		4314	3936	4101
Cumulative costs:		22905	21149	21771
Differential savings		0	1756	1134

*Average cost of ischemic stroke treatment in Ontario according to Goeree et al, 2005.
Please note that the costs are substantially higher for more severe stroke patients: costs for patients with Modified Rankin Score 4 = 100,000$CDN and score 5 = 200,000$CDN.
**NPV calculation assumes 3% annual interest rate.