Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

Pharmacogenomics J. 2016 Oct;16(5):478-84. doi: 10.1038/tpj.2016.41. Epub 2016 Jun 7.

Abstract

We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per quality-adjusted life-year (QALY) gained by pharmacogenetic-guided warfarin dosing versus standard treatment over a lifetime horizon. Incremental lifetime costs were £26 and 382 Swedish kronor (SEK) and incremental QALYs were 0.0039 and 0.0015 in the United Kingdom and Sweden, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were £6 702 and 253 848 SEK per QALY gained. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 93% of the simulations in the United Kingdom and below 500 000 SEK in 67% of the simulations in Sweden. Our data suggest that pharmacogenetic-guided dosing of warfarin is a cost-effective strategy to improve outcomes of patients with AF treated with warfarin in the United Kingdom and in Sweden.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Anticoagulants / economics*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / economics*
  • Atrial Fibrillation / genetics
  • Cost-Benefit Analysis
  • Cytochrome P-450 CYP2C9 / genetics
  • Drug Costs*
  • Drug Dosage Calculations
  • Drug Monitoring / economics
  • Female
  • Humans
  • International Normalized Ratio / economics
  • Male
  • Markov Chains
  • Models, Economic
  • Patient Selection
  • Pharmacogenetics / economics*
  • Pharmacogenomic Testing / economics*
  • Pharmacogenomic Variants
  • Precision Medicine / economics
  • Predictive Value of Tests
  • Quality of Life
  • Quality-Adjusted Life Years
  • Randomized Controlled Trials as Topic
  • Sweden
  • Treatment Outcome
  • United Kingdom
  • Vitamin K Epoxide Reductases / genetics
  • Warfarin / administration & dosage*
  • Warfarin / adverse effects
  • Warfarin / economics*

Substances

  • Anticoagulants
  • Warfarin
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases