Cost-effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation

Aim: To investigate the cost effectiveness of pharmacogenetic-guided phenprocoumon dosing versus standard anticoagulation care in Dutch patients with atrial fibrillation. Materials & 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 (sic)15. The incremental cost effectiveness ratio was (sic)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 (sic)20,000 per QALY gained in 75.6% of the simulations. Conclusion: 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