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.

Original submitted 20 December 2012; Revision submitted 8 April 2013

KEYWORDS::

• atrial fibrillation
• cost–effectiveness
• coumarins
• CYP2C9
• health economics
• pharmacogenetics
• phenprocoumon
• VKORC1

Financial & competing interests disclosure

This project is funded by the EU 7th Framework Program (FP7) under grant agreement HEALTH-F2-2009-223062. The Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, employing authors TI Verhoef, R van Schie, A de Boer and A-H Maitland-van der Zee, has received unrestricted research funding from The Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private–public funded Top Institute Pharma (www.tipharma.nl, includes cofunding from universities, government and industry), the EU Innovative Medicines Initiative (IMI), EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, and the Dutch Ministry of Health and Industry (including GlaxoSmithKline, Pfizer and others). The authors have no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Additional information

Funding

This project is funded by the EU 7th Framework Program (FP7) under grant agreement HEALTH-F2-2009-223062. The Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, employing authors TI Verhoef, R van Schie, A de Boer and A-H Maitland-van der Zee, has received unrestricted research funding from The Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private–public funded Top Institute Pharma (www.tipharma.nl, includes cofunding from universities, government and industry), the EU Innovative Medicines Initiative (IMI), EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board, and the Dutch Ministry of Health and Industry (including GlaxoSmithKline, Pfizer and others). The authors have no other 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 apart from those disclosed. No writing assistance was utilized in the production of this manuscript.