title: A systematic review of cost-effectiveness analyses of pharmacogenetic-guided dosing in treatment with coumarin derivatives.
abstract: Anticoagulant therapy with coumarin derivatives is often sub- or supra-therapeutic, resulting in an increased risk of thromboembolic events or hemorrhage, respectively. Pharmacogenetic-guided dosing has been proposed as an effective way of reducing bleeding rates. Clinical trials to confirm the safety, efficacy and effectiveness of this strategy are ongoing, but in addition, it is also necessary to consider the cost-effectiveness of this strategy. This article describes the findings of a systematic review of published cost-effectiveness analyses of pharmacogenetic-guided dosing of coumarin derivatives. Similarities and differences in the approaches used were examined and the quality of the analyses was assessed. The results of the analyses are not sufficient to determine whether or not pharmacogenetic-guided dosing of coumarins is cost effective. More reliable cost-effectiveness estimates need to become available before it is possible to recommend whether or not this strategy should be applied in clinical practice.
authors.affiliation: Division of Pharmacoepidemiology & Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands.
authors.forename: Talitha I
authors.initials: TI
authors.lastname: Verhoef
authors.forename: William K
authors.initials: WK
authors.lastname: Redekop
authors.forename: Josep
authors.initials: J
authors.lastname: Darba
authors.forename: Mary
authors.initials: M
authors.lastname: Geitona
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Anthonius
authors.initials: A
authors.lastname: de Boer
authors.forename: Anke-Hilse
authors.initials: AH
authors.lastname: Maitland-van der Zee
authors.forename: Rita
authors.initials: R
authors.lastname: Barallon
authors.forename: Montserrat
authors.initials: M
authors.lastname: Briz
authors.forename: Ann
authors.initials: A
authors.lastname: Daly
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Haschke-Becher
authors.forename: Farhad
authors.initials: F
authors.lastname: Kamali
authors.forename: Julia
authors.initials: J
authors.lastname: Kirchheiner
authors.forename: Vangelis G
authors.initials: VG
authors.lastname: Manolopoulos
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: Rianne M F
authors.initials: RM
authors.lastname: van Schie
authors.forename: Mia
authors.initials: M
authors.lastname: Wadelius
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D003374:Coumarins / Q000008:administration & dosage* / Q000191:economics*; D004305:Dose-Response Relationship, Drug; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010597:Pharmacogenetics / Q000379:methods*
chemical_list: D000925:Anticoagulants; D003374:Coumarins