Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, 633-165 Gaegum 2-dong, Busan Jin-gu, Busan, Republic of Korea.
Department of Clinical Pharmacology, Inje University Busan Paik Hospital, 633-165 Gaegum 2-dong, Busan Jin-gu, Busan, Republic of Korea.
Appl Health Econ Health Policy. 2017 Oct;15(5):657-667. doi: 10.1007/s40258-017-0317-y.
Although studies assessing the cost effectiveness of genotype-guided warfarin dosing for the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolism have been reported, no publications have addressed genotype-guided warfarin therapy in mechanical heart valve replacement (MHVR) patients or genotype-guided warfarin therapy under the fee-for-service (FFS) insurance system.
The aim of this study was to evaluate the cost effectiveness of genotype-guided warfarin dosing in patients with MHVR under the FFS system from the Korea healthcare sector perspective.
A decision-analytic Markov model was developed to evaluate the cost effectiveness of genotype-guided warfarin dosing compared with standard dosing. Estimates of clinical adverse event rates and health state utilities were derived from the published literature. The outcome measure was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were performed to explore the range of plausible results.
In a base-case analysis, genotype-guided warfarin dosing was associated with marginally higher QALYs than standard warfarin dosing (6.088 vs. 6.083, respectively), at a slightly higher cost (US$6.8) (year 2016 values). The ICER was US$1356.2 per QALY gained. In probabilistic sensitivity analysis, there was an 82.7% probability that genotype-guided dosing was dominant compared with standard dosing, and a 99.8% probability that it was cost effective at a willingness-to-pay threshold of US$50,000 per QALY gained.
Compared with only standard warfarin therapy, genotype-guided warfarin dosing was cost effective in MHVR patients under the FFS insurance system.
虽然已经有研究评估了基因指导华法林剂量调整在房颤、深静脉血栓和肺栓塞管理方面的成本效益，但尚无出版物涉及机械心脏瓣膜置换（MHVR）患者的基因指导华法林治疗或按服务计费（FFS）保险系统下的基因指导华法林治疗。
本研究旨在从韩国医疗保健部门的角度评估 FFS 系统下 MHVR 患者基因指导华法林剂量调整的成本效益。
开发了一个决策分析马尔可夫模型，以评估基因指导华法林剂量调整与标准剂量相比的成本效益。临床不良事件发生率和健康状态效用的估计值来自已发表的文献。结果测量指标是每质量调整生命年（QALY）的增量成本效益比（ICER）。进行了单因素和概率敏感性分析，以探索合理结果的范围。
在基线分析中，与标准华法林治疗相比，基因指导华法林剂量调整与略高的 QALYs（分别为 6.088 和 6.083）相关，成本略高（6.8 美元）（2016 年的价值）。ICER 为每获得一个 QALY 增加 1356.2 美元。在概率敏感性分析中，基因指导剂量调整与标准剂量相比具有 82.7%的优势概率，在每获得一个 QALY 增加 50000 美元的意愿支付阈值下，有 99.8%的概率是具有成本效益的。
与仅标准华法林治疗相比，FFS 保险系统下 MHVR 患者的基因指导华法林剂量调整具有成本效益。
