title: Economic evaluation of pharmacogenomic-guided warfarin treatment for elderly Croatian atrial fibrillation patients with ischemic stroke.
abstract: METHODS
  Economic evaluation in genomic medicine is an emerging discipline to assess the cost-effectiveness of genome-guided treatment. Here, we developed a pharmaco-economic model to assess whether pharmacogenomic (PGx)-guided warfarin treatment of elderly ischemic stroke patients with atrial fibrillation in Croatia is cost effective compared with non-PGx therapy. The time horizon of the model was set at 1 year.
  
  
  RESULTS
  Our primary analysis indicates that 97.07% (95% CI: 94.08-99.34%) of patients belonging to the PGx-guided group have not had any major complications, compared with the control group (89.12%; 95% CI: 84.00-93.87%, p < 0.05). The total cost per patient was estimated at €538.7 (95% CI: €526.3-551.2) for the PGx-guided group versus €219.7 (95% CI: €137.9-304.2) for the control group. In terms of quality-adjusted life-years (QALYs) gained, total QALYs was estimated at 0.954 (95% CI: 0.943-0.964) and 0.944 (95% CI: 0.931-0.956) for the PGx-guided and the control groups, respectively. The true difference in QALYs was estimated at 0.01 (95% CI: 0.005-0.015) in favor of the PGx-guided group. The incremental cost-effectiveness ratio of the PGx-guided versus the control groups was estimated at €31,225/QALY.
  
  
  CONCLUSIONS
  Overall, our data indicate that PGx-guided warfarin treatment may represent a cost-effective therapy option for the management of elderly patients with atrial fibrillation who developed ischemic stroke in Croatia.
authors.affiliation: Department of Clinical Chemistry, Faculty of Medicine & Health Sciences, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Christina
authors.initials: C
authors.lastname: Mitropoulou
authors.forename: Vasilios
authors.initials: V
authors.lastname: Fragoulakis
authors.forename: Nada
authors.initials: N
authors.lastname: Bozina
authors.forename: Athanassios
authors.initials: A
authors.lastname: Vozikis
authors.forename: Svjetlana
authors.initials: S
authors.lastname: Supe
authors.forename: Tamara
authors.initials: T
authors.lastname: Bozina
authors.forename: Zdravka
authors.initials: Z
authors.lastname: Poljakovic
authors.forename: Ron H
authors.initials: RH
authors.lastname: van Schaik
authors.forename: George P
authors.initials: GP
authors.lastname: Patrinos
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D017523:Croatia; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010597:Pharmacogenetics / Q000191:economics* / Q000379:methods; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: atrial fibrillation; cost–effectiveness analysis; ischemic stroke; pharmacogenomics economic evaluation; warfarin