title: Cost-effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of pharmacogenetic-guided phenprocoumon dosing versus standard anticoagulation care in Dutch patients with atrial fibrillation.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, 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: David L
authors.initials: DL
authors.lastname: Veenstra
authors.forename: Rahber
authors.initials: R
authors.lastname: Thariani
authors.forename: Peter A
authors.initials: PA
authors.lastname: Beltman
authors.forename: Rianne Mf
authors.initials: RM
authors.lastname: van Schie
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 / Q000008:administration & dosage / Q000191:economics; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D065729:Cytochrome P-450 CYP2C9; D003661:Decision Support Techniques; D005838:Genotype; D006801:Humans; D008390:Markov Chains; D010597:Pharmacogenetics / Q000379:methods; D010644:Phenprocoumon / Q000008:administration & dosage* / Q000191:economics; D014859:Warfarin / Q000008:administration & dosage / Q000191:economics
chemical_list: D000925:Anticoagulants; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; D010644:Phenprocoumon