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

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

doi:10.2217/pgs.13.74

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

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

Pharmacoepidemiology and Clinical Pharmacology

Research output: Contribution to journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	869-83
Number of pages	15
Journal	Pharmacogenomics
Volume	14
Issue number	8
DOIs	https://doi.org/10.2217/pgs.13.74
Publication status	Published - Jun 2013

Keywords

Anticoagulants
Aryl Hydrocarbon Hydroxylases
Atrial Fibrillation
Cost-Benefit Analysis
Cytochrome P-450 CYP2C9
Decision Support Techniques
Genotype
Humans
Markov Chains
Pharmacogenetics
Phenprocoumon
Warfarin

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title = "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.",

keywords = "Anticoagulants, Aryl Hydrocarbon Hydroxylases, Atrial Fibrillation, Cost-Benefit Analysis, Cytochrome P-450 CYP2C9, Decision Support Techniques, Genotype, Humans, Markov Chains, Pharmacogenetics, Phenprocoumon, Warfarin",

author = "Verhoef, {Talitha I} and Redekop, {William K} and Veenstra, {David L} and Rahber Thariani and Beltman, {Peter A} and {van Schie}, {Rianne Mf} and {de Boer}, Anthonius and {Maitland-van der Zee}, Anke-Hilse and {EU-PACT Group}",

year = "2013",

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doi = "10.2217/pgs.13.74",

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journal = "Pharmacogenomics",

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AU - Verhoef, Talitha I

AU - Redekop, William K

AU - Veenstra, David L

AU - Thariani, Rahber

AU - Beltman, Peter A

AU - van Schie, Rianne Mf

AU - de Boer, Anthonius

AU - Maitland-van der Zee, Anke-Hilse

AU - EU-PACT Group

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

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KW - Genotype

KW - Humans

KW - Markov Chains

KW - Pharmacogenetics

KW - Phenprocoumon

KW - Warfarin

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JO - Pharmacogenomics

JF - Pharmacogenomics

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

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Keywords

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