title: Economic evaluation of a pharmacogenetic dosing algorithm for coumarin anticoagulants in The Netherlands.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of a pharmacogenetic dosing algorithm versus a clinical dosing algorithm for coumarin anticoagulants in The Netherlands.
  
  
  METHODS
  A decision-analytic Markov model was used to analyze the cost-effectiveness of pharmacogenetic dosing of phenprocoumon and acenocoumarol versus clinical dosing.
  
  
  RESULTS
  Pharmacogenetic dosing increased costs by €33 and quality-adjusted life-years (QALYs) by 0.001. The incremental cost-effectiveness ratios were €28,349 and €24,427 per QALY gained for phenprocoumon and acenocoumarol, respectively. At a willingness-to-pay threshold of €20,000 per QALY, the pharmacogenetic dosing algorithm was not likely to be cost effective compared with the clinical dosing algorithm.
  
  
  CONCLUSIONS
  Pharmacogenetic dosing improves health only slightly when compared with clinical dosing. However, availability of low-cost genotyping would make it a cost-effective option.
authors.affiliation: Utrecht Institute 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: Anthonius
authors.initials: A
authors.lastname: de Boer
authors.forename: Anke Hilse
authors.initials: AH
authors.lastname: Maitland-van der Zee
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis / Q000379:methods; D003374:Coumarins / Q000008:administration & dosage* / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D010597:Pharmacogenetics / Q000191:economics / Q000379:methods*; D010644:Phenprocoumon / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D013923:Thromboembolism / Q000191:economics / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D000074:Acenocoumarol; D010644:Phenprocoumon
keywords: acenocoumarol; atrial fibrillation; health economics; pharmacogenetics; phenprocoumon