title: Cost-effectiveness of pharmacogenetics in anticoagulation: international differences in healthcare systems and costs.
abstract: Genotyping patients for CYP2C9 and VKORC1 polymorphisms can improve the accuracy of dosing during the initiation of anticoagulation with vitamin K antagonists (coumarin derivatives). The anticipated degree of improvement in the safety of anticoagulation with coumarins through genotyping may vary depending on the quality of patient care, which varies both with and among countries. The management and the cost of anticoagulant care can therefore influence the cost-effectiveness of genotyping within any given country. In this article, we provide an overview of the cost-effectiveness of pharmacogenetics-guided dosing of coumarin derivatives. We describe the organization of anticoagulant care in the UK, Sweden, The Netherlands, Greece, Germany and Austria, where a genotype-guided dosing algorithm is currently being investigated as part of the EU-PACT trial. We also explore the costs of anticoagulant care for the treatment of atrial fibrillation in these countries.
authors.affiliation: Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, 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: Rianne Mf
authors.initials: RM
authors.lastname: van Schie
authors.forename: Samira
authors.initials: S
authors.lastname: Bayat
authors.forename: Ann K
authors.initials: AK
authors.lastname: Daly
authors.forename: Mary
authors.initials: M
authors.lastname: Geitona
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Haschke-Becher
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
authors.forename: Farhad
authors.initials: F
authors.lastname: Kamali
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
authors.forename: Vangelis G
authors.initials: VG
authors.lastname: Manolopoulos
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.forename: Julia C
authors.initials: JC
authors.lastname: Stingl
authors.forename: Mia
authors.initials: M
authors.lastname: Wadelius
authors.forename: Anthonius
authors.initials: A
authors.lastname: de Boer
authors.forename: Anke-Hilse
authors.initials: AH
authors.lastname: Maitland-van der Zee
mesh_terms: D000925:Anticoagulants / Q000191:economics* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000191:economics / Q000235:genetics; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics*; D005838:Genotype; D006801:Humans; D010597:Pharmacogenetics / Q000191:economics* / Q000379:methods
chemical_list: D000925:Anticoagulants