title: Universal versus genotype-guided use of direct oral anticoagulants in atrial fibrillation patients: a decision analysis.
abstract: OBJECTIVE
  This study aims to compare clinical and economic outcomes of CYP2C9 and VKORC1 genotype-guided (PG-DOAC) versus universal use of direct oral anticoagulant (DOAC) for stroke prevention in patients with atrial fibrillation (AF).
  
  
  METHODS
  Outcomes of oral anticoagulation therapy were simulated using life-long Markov modeling. In PG-DOAC, patients with genotype of high or low warfarin sensitivity were treated with DOAC, and patients with normal warfarin sensitivity genotype received warfarin.
  
  
  RESULTS
  Expected quality-adjusted life-years (QALYs) and cost of DOAC were higher than PG-DOAC. Incremental cost per QALY (ICER) of DOAC versus PG-DOAC was 314,129 USD/QALY, exceeding willingness-to-pay threshold (50,000 USD/QALY).
  
  
  CONCLUSIONS
  Using individual genotype to guide the use of DOAC versus warfarin appears to be the preferred strategy.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China SAR.
authors.forename: Joyce H S
authors.initials: JH
authors.lastname: You
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000235:genetics*; D003362:Cost-Benefit Analysis / Q000379:methods; D065729:Cytochrome P-450 CYP2C9 / Q000235:genetics; D003661:Decision Support Techniques; D005838:Genotype; D006801:Humans; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000235:genetics / Q000517:prevention & control; D064417:Vitamin K Epoxide Reductases / Q000235:genetics; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases
keywords: CYP2C9; VKORC1; atrial fibrillation; cost–effectiveness analysis; direct oral anticoagulant; genotype-guided therapy; warfarin