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ABSTRACT
Background: Sub-analyses from the BEST trial in heart failure (HF) indicated that Arg389 homozygote patients may respond to bucindolol. Bucindolol is currently being evaluated in Arg389 genotype patients in the GENETIC-AF trial. Our aim is to conduct ex ante economic evaluations of Arg389 genetic testing to support β-blocker treatment in HF.
Methods: Using survival results from two BEST sub-analyses, we constructed a decision-tree model (time-horizon 18 months, divided into three 6-month cycles) to estimate the cost-effectiveness/utility of Arg389 genetic testing with bucindolol or carvedilol versus no testing and empirical bucindolol. Costs of bucindolol and genetic testing were set conservatively at 1.5x carvedilol cost and $250, respectively. Incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were estimated.
Results: Per one BEST sub-analysis, Arg389 genetic testing was associated with incremental gains of 0.29 life-years (LYs) and 0.27 quality-adjusted life years (QALYs) at incremental costs of $726; yielding ICER of US$2,503/LY and ICUR of US$2,688/QALY gained. Per a different BEST sub-analysis, Arg-389 genetic testing was associated with incremental gains of 0.35LYs and 0.32QALYs at savings of (US$1,081); for ICER of (US$3,089)/LY and ICUR of (US$3,378)/QALY gained.
Conclusions: Assuming conservative cost estimates, Arg389 genetic testing to inform bucindolol versus carvedilol treatment decisions prevailed economically over bucindolol treatment without genetic testing.
Author contributions
Concept and overall approach: N.A., K.R., N.S., I.A. Study design: N.A., I.A. Analytics: N.A., M.G. Interpretation of results: N.A., K.R., M.S., B.E., M.G., W.K., M.L., J.K., N.S., I.A. Clinical guidance: N.A., K.R., N.S., I.A. Drafting of the manuscript: N.A., I.A. Critical review of manuscript: K.R., M.S., B.E., M.G., W.K., M.L., J.K., N.S.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.