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Clopidogrel is an antiplatelet drug given to patients before and after having a percutaneous coronary intervention (PCI). Genomic variants in the CYP2C19 gene are associated with variable enzyme activities affecting drug metabolism and hence, patients with reduced or increased enzymatic function have increased risk of bleeding. We conducted a cost-effectiveness analysis to compare a pharmacogenomics versus a non-pharmacogenomics-guided clopidogrel treatment for coronary artery syndrome patients undergoing PCI in the Spanish healthcare setting. A total of 549 patients diagnosed with coronary artery disease followed by PCI were recruited. Dual antiplatelet therapy was administrated to all patients from 1 to 12 months after PCI. Patients were classified into two groups: the Retrospective group was treated with clopidogrel based on the clinical routine practice and the Prospective group were initially genotyped for the presence of CYP2C19 variant alleles before treatment with those carrying more than one CYP2C19 variant alleles given prasugrel treatment. We collected data on established clinical and health outcome measures, including, per treatment arm: the percentage of patients that suffered from (a) myocardial infraction, (b) major bleeding and minor bleeding, (c) stroke, (d) the number of hospitalization days, and (e) the number of days patients spent in Intensive Care Unit. Our primary outcome measure for the cost-effectiveness analysis was Quality Adjusted Life Years (QALYs). To estimate the treatment cost for each patient, individual data on its resource used were combined with unit price data, obtained from Spanish national sources. The analysis predicts a survival of 0.9446 QALYs in the pharmacogenomics arm and 0.9379 QALYs in the non-pharmacogenomics arm within a 1-year horizon. The cumulative costs per patient were €2971 and €3205 for the Prospective and Retrospective groups, respectively. The main cost driver of total cost in both arms was hospitalization costs. The incremental cost-effectiveness ratio (ICER) was negative indicating that the PGx was a dominant option. Our data show that pharmacogenomics-guided clopidogrel treatment strategy may represent a cost-effective choice compared with non-pharmacogenomics-guided strategy for patients undergoing PCI.

Despite the significant progress in the last few decades, road safety improvement still constitutes an imperative global need. Especially in urban areas, the improvement of road safety is an even more complicated and multi-factor problem. Every minute, a human life is lost in an urban road network in the world. Given that almost all road accidents are preventable, more effective planning toward improving road safety, as a structural element of sustainable urban mobility, is imperative. The aim of the present research is to provide decision support analysts and policy-makers with a decision-support tool that identifies and prioritizes the factors undermining road safety in an urban area, with a view to developing effective policies. For this purpose, a comprehensive inventory of factors that may undermine road safety in an urban area, as well as an inventory of relevant measures and policies, is provided, based on an international literature review. The most important factors and, subsequently, the most effective measures and policies are identified and prioritized through a multi-criteria approach (modified Delphi–analytical hierarchy process (AHP)–technique for order preference by similarity to ideal solution (TOPSIS)). The Greek urban road networks, starting from the second largest city in Greece (Thessaloniki), are selected as a case study. Problems related to limited resources not allowing for systematic surveillance and policing, making arbitrary decisions instead of adopting a scientific decision-aiding methodology, education and mentality issues, infrastructure planning and maintenance, cooperation and coordination between different authorities, and laxity of penalties are highlighted as the most important factors, based on which four sets of measures and policies are identified and prioritized.