Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands.
Pharmacogenomics. 2013 Jun;14(8):869-83. doi: 10.2217/pgs.13.74.
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.
Compared with standard care, the pharmacogenetic-guided dosing strategy increased quality-adjusted life-years (QALYs) only very slightly and increased costs by €15. The incremental cost-effectiveness ratio was €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 €20,000 per QALY gained in 75.6% of the simulations.
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.
研究在荷兰房颤患者中，基于遗传药理学的苯丙香豆素剂量调整与标准抗凝治疗相比的成本效益。
采用决策分析马尔可夫模型，估算了遗传药理学治疗与标准治疗的成本效益。
与标准治疗相比，基于遗传药理学的剂量调整策略仅略微增加了质量调整生命年（QALY），并增加了 15 欧元的成本。增量成本效益比为每获得一个 QALY 增加 2658 欧元。在敏感性分析中，基因分型的成本对成本效益比的影响最大。在概率敏感性分析中，在 75.6%的模拟中，基于基因型指导的剂量调整的增量成本低于每个 QALY 获得 20000 欧元。
基于遗传药理学的苯丙香豆素剂量调整可能会略微提高健康水平，并且可能以具有成本效益的方式实现这一目标。由于存在许多不确定性，现在还为时过早，无法确定开始使用苯丙香豆素的患者是否应该进行基因分型。
