Mitropoulou Christina, Fragoulakis Vasilios, Bozina Nada, Vozikis Athanassios, Supe Svjetlana, Bozina Tamara, Poljakovic Zdravka, van Schaik Ron H, Patrinos George P
Department of Clinical Chemistry, Faculty of Medicine & Health Sciences, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Pharmacogenomics. 2015 Jan;16(2):137-48. doi: 10.2217/pgs.14.167.
BACKGROUND & METHODS: Economic evaluation in genomic medicine is an emerging discipline to assess the cost-effectiveness of genome-guided treatment. Here, we developed a pharmaco-economic model to assess whether pharmacogenomic (PGx)-guided warfarin treatment of elderly ischemic stroke patients with atrial fibrillation in Croatia is cost effective compared with non-PGx therapy. The time horizon of the model was set at 1 year.
Our primary analysis indicates that 97.07% (95% CI: 94.08-99.34%) of patients belonging to the PGx-guided group have not had any major complications, compared with the control group (89.12%; 95% CI: 84.00-93.87%, p < 0.05). The total cost per patient was estimated at €538.7 (95% CI: €526.3-551.2) for the PGx-guided group versus €219.7 (95% CI: €137.9-304.2) for the control group. In terms of quality-adjusted life-years (QALYs) gained, total QALYs was estimated at 0.954 (95% CI: 0.943-0.964) and 0.944 (95% CI: 0.931-0.956) for the PGx-guided and the control groups, respectively. The true difference in QALYs was estimated at 0.01 (95% CI: 0.005-0.015) in favor of the PGx-guided group. The incremental cost-effectiveness ratio of the PGx-guided versus the control groups was estimated at €31,225/QALY.
Overall, our data indicate that PGx-guided warfarin treatment may represent a cost-effective therapy option for the management of elderly patients with atrial fibrillation who developed ischemic stroke in Croatia.
基因组医学中的经济评估是一门新兴学科，用于评估基因组引导治疗的成本效益。在此，我们建立了一个药物经济学模型，以评估在克罗地亚，与非药物基因组学（PGx）治疗相比，基于药物基因组学（PGx）指导对华法林治疗老年缺血性中风合并房颤患者是否具有成本效益。该模型的时间范围设定为1年。
我们的初步分析表明，PGx指导组97.07%（95%置信区间：94.08 - 99.34%）的患者未发生任何重大并发症，而对照组为89.12%（95%置信区间：84.00 - 93.87%，p < 0.05）。PGx指导组每位患者的总成本估计为538.7欧元（95%置信区间：526.3 - 551.2欧元），而对照组为219.7欧元（95%置信区间：137.9 - 304.2欧元）。就获得的质量调整生命年（QALY）而言，PGx指导组和对照组的总QALY分别估计为0.954（95%置信区间：0.943 - 0.964）和0.944（95%置信区间：0.931 - 0.956）。QALY的真实差异估计为0.01（95%置信区间：0.005 - 0.015），有利于PGx指导组。PGx指导组与对照组的增量成本效益比估计为31,225欧元/QALY。
总体而言，我们的数据表明，对于克罗地亚患有缺血性中风的老年房颤患者，PGx指导的华法林治疗可能是一种具有成本效益的治疗选择。
