Cost–Effectiveness of Pharmacogenetics in Anticoagulation: International Differences in Healthcare Systems and Costs

Abstract

Genotyping patients for CYP2C9 and VKORC1 polymorphisms can improve the accuracy of dosing during the initiation of anticoagulation with vitamin K antagonists (coumarin derivatives). The anticipated degree of improvement in the safety of anticoagulation with coumarins through genotyping may vary depending on the quality of patient care, which varies both with and among countries. The management and the cost of anticoagulant care can therefore influence the cost-effectiveness of genotyping within any given country. In this article, we provide an overview of the cost-effectiveness of pharmacogenetics-guided dosing of coumarin derivatives. We describe the organization of anticoagulant care in the UK, Sweden, The Netherlands, Greece, Germany and Austria, where a genotype-guided dosing algorithm is currently being investigated as part of the EU-PACT trial. We also explore the costs of anticoagulant care for the treatment of atrial fibrillation in these countries.

Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

“…We performed two country-specific cost-effectiveness analyses because of between-country differences in the health-care system (that is, structure, cost) and quality of standard anticoagulant care. 13 …”

Genotype‐guided warfarin therapy: Still of only questionable value two decades on

“…Furthermore, given that approximately 60% of the variability in dose/response to warfarin is due to factors other than CYP2C9/VKORC1 genotypes and that other genetic markers of risk continue to be reported, it may be over‐optimistic to expect current genotyping strategies alone to significantly enhance the safety and effectiveness of warfarin therapy in the majority of patients in routine clinical settings. Not unexpectedly, therefore, cost‐effectiveness of genotype‐guided warfarin dosing remains controversial, especially since this varies with geography depending on local health economics or patient population studied …”

Economic Evaluation of a Pharmacogenetic Dosing Algorithm for Coumarin Anticoagulants in the Netherlands

“…We have described in a previous review the different costs associated with coumarin anticoagulant therapy for different European countries, including The Netherlands [25]. We used these costs in our model unless more recent information was available [26][27][28][29].…”