Cost-effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation.

Abstract

AIM:

To investigate the cost-effectiveness of pharmacogenetic-guided phenprocoumon dosing versus standard anticoagulation care in Dutch patients with atrial fibrillation.

MATERIALS & METHODS:

Using a decision-analytic Markov model, cost-effectiveness of pharmacogenetic-guided therapy versus standard care was estimated.

RESULTS:

Compared with standard care, the pharmacogenetic-guided dosing strategy increased quality-adjusted life-years (QALYs) only very slightly and increased costs by €15. The incremental cost-effectiveness ratio was €2658 per QALY gained. In sensitivity analyses, the cost of genotyping had the largest influence on the cost-effectiveness ratio. In a probabilistic sensitivity analysis, the incremental costs of genotype-guided dosing were less than €20,000 per QALY gained in 75.6% of the simulations.

CONCLUSION:

Pharmacogenetic-guided dosing of phenprocoumon has the potential to increase health slightly and may be able to achieve this in a cost-effective way. Owing to the many uncertainties it is too early to conclude whether or not patients starting phenprocoumon should be genotyped.

• Authors: Talitha I Verhoef, William K Redekop, David L Veenstra, Rahber Thariani, Peter A Beltman, Rianne Mf van Schie, Anthonius de Boer, Anke-Hilse Maitland-van der Zee, EU-PACT Group
• Journal: Pharmacogenomics (Pharmacogenomics) Vol. 14 Issue 8 Pg. 869-83 (Jun 2013) ISSN: 1744-8042 [Electronic] England
• PMID: 23746182 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Warfarin
• CYP2C9 protein, human
• Cytochrome P-450 CYP2C9
• Aryl Hydrocarbon Hydroxylases
• Phenprocoumon

Topics

• Anticoagulants (administration & dosage, economics)
• Aryl Hydrocarbon Hydroxylases (genetics)
• Atrial Fibrillation (drug therapy, economics, pathology)
• Cost-Benefit Analysis
• Cytochrome P-450 CYP2C9
• Decision Support Techniques
• Genotype
• Humans
• Markov Chains
• Pharmacogenetics (methods)
• Phenprocoumon (administration & dosage, economics)
• Warfarin (administration & dosage, economics)