Cost–effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation. (June 2013)

• Record Type: Journal Article
• Authors: Verhoef, Talitha I; Redekop, William K; Veenstra, David L; Thariani, Rahber; Beltman, Peter A; van Schie, Rianne MF; de Boer, Anthonius; Maitland-van der Zee, Anke-Hilse
• Is Part Of: Pharmacogenomics. Volume 14:Number 8(2013)
• Page Start: 869
• Page End: 883
• Publication Date: 2013-06
• Subjects: atrial fibrillation -- cost–effectiveness -- coumarins -- CYP2C9 -- health economics -- pharmacogenetics -- phenprocoumon -- VKORC1; Pharmacogenomics -- Periodicals; 615.1
• DOI: 10.2217/pgs.13.74
• Languages: English
• ISSNs: 1462-2416

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. Original submitted 20 December 2012; Revision submitted 8 April 2013