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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Keywords CYP2C9 gene, Netherlands, VKORC1 gene, anticoagulant therapy, article, bleeding, brain hemorrhage, cerebrovascular accident, cost effectiveness analysis, cost utility analysis, gastrointestinal hemorrhage, genotype, heart atrium fibrillation, human, international normalized ratio, mortality, pharmacogenetics, quality adjusted life year, thromboembolism, transient ischemic attack
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Journal Pharmacogenomics
Grant This work was funded by the European Commission 7th Framework Programme; grant id fp7/223062 - A pharmacogenomic approach to coumarin anticoagulant therapy (EU-PACT)
Verhoef, T.I, Redekop, W.K, Veenstra, D.L, Thariani, R, Beltman, P.A, van Schie, R.F.M, … Maitland-van der Zee, A-H. (2013). Cost-effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation. Pharmacogenomics, 14(8), 869–883. doi:10.2217/pgs.13.74