Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden.
We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per quality-adjusted life-year (QALY) gained by pharmacogenetic-guided warfarin dosing versus standard treatment over a lifetime horizon. Incremental lifetime costs were £26 and 382 Swedish kronor (SEK) and incremental QALYs were 0.0039 and 0.0015 in the United Kingdom and Sweden, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were £6 702 and 253 848 SEK per QALY gained. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 93% of the simulations in the United Kingdom and below 500 000 SEK in 67% of the simulations in Sweden. Our data suggest that pharmacogenetic-guided dosing of warfarin is a cost-effective strategy to improve outcomes of patients with AF treated with warfarin in the United Kingdom and in Sweden.
Department of Applied Health Research, University College London, London, UK.|Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
T I
TI
Verhoef
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
W K
WK
Redekop
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.|Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
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S
Langenskiold
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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F
Kamali
Department of Medical Sciences, Clinical Pharmacology, and Science for Life Laboratory Uppsala University, Uppsala, Sweden.
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M
Wadelius
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
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G
Burnside
Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
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AH
Maitland-van der Zee
Centre for Health Economics & Medicines Evaluation, Bangor University, North Wales, UK.
D A
DA
Hughes
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
M
M
Pirmohamed
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000235:genetics; D003362:Cost-Benefit Analysis; D065729:Cytochrome P-450 CYP2C9 / Q000235:genetics; D016527:Drug Costs; D054796:Drug Dosage Calculations; D016903:Drug Monitoring / Q000191:economics; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000191:economics; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D018579:Patient Selection; D010597:Pharmacogenetics / Q000191:economics*; D000071185:Pharmacogenomic Testing / Q000191:economics*; D000071184:Pharmacogenomic Variants; D057285:Precision Medicine / Q000191:economics; D011237:Predictive Value of Tests; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013548:Sweden; D016896:Treatment Outcome; D006113:United Kingdom; D064417:Vitamin K Epoxide Reductases / Q000235:genetics; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*
D000925:Anticoagulants; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases