Cost-Effectiveness of Using Pharmacogenetic Information in Warfarin Dosing for Patients With Nonvalvular Atrial Fibrillation
Cost-Effectiveness of Using Pharmacogenetic Information in Warfarin Dosing for Patients With Nonvalvular Atrial Fibrillation
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DOI：
10.7326/0003-4819-150-2-200901200-00005
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发表时间：
2009-01-20
影响因子：
39.2
通讯作者：
Gage, Brian F.
中科院分区：
文献类型：
--
作者：
Eckman, Mark H.;Rosand, Jonathan;Gage, Brian F.
背景：华法林代谢和敏感性相关基因的变异影响个体华法林需求和出血风险。检测这些变异等位基因可能允许在诱导阶段更个性化地给华法林剂量。2007年，美国S.美国食品和药物管理局改变了华法林的标签（Coumadin，Bristol-Myers Squibb，Princeton，新泽西），建议临床医生在开始治疗前考虑基因检测。目的：研究非瓣膜性房颤患者基因型指导剂量与标准诱导华法林治疗的成本效益。设计：马尔可夫状态转换决策模型。数据来源：MEDLINE检索和参考书目来自英文发表的相关文献。目标人群：需要开始华法林治疗的门诊或住院患者。基础病例是一名69岁的男性，新诊断为非瓣膜性房颤，无华法林治疗禁忌症。时间范围：终生。视角：社会。干预：基因型指导给药，包括CYP 2C 9 *2、CYP 2C 9 *3和/或VKORC 1的基因分型与标准华法林诱导。结果测量：有效性是以质量调整生命年（Qs）来衡量的，成本是2007年美国的。S.结果：在基础病例中，基因型指导给药导致更好的结果，但成本相对较高。总体而言，测试的边际成本效益超过170 000美元每QALY。根据目前的数据和测试成本（约400美元），只有10%的机会，基因型指导剂量可能是具有成本效益的（即，
Background: Variants in genes involved in warfarin metabolism and sensitivity affect individual warfarin requirements and the risk for bleeding. Testing for these variant alleles might allow more personalized dosing of warfarin during the induction phase. In 2007, the U. S. Food and Drug Administration changed the labeling for warfarin (Coumadin, Bristol-Myers Squibb, Princeton, New Jersey), suggesting that clinicians consider genetic testing before initiating therapy.Objective: To examine the cost-effectiveness of genotype-guided dosing versus standard induction of warfarin therapy for patients with nonvalvular atrial fibrillation.Design: Markov state transition decision model.Data Sources: MEDLINE searches and bibliographies from relevant articles of literature published in English.Target Population: Outpatients or inpatients requiring initiation of warfarin therapy. The base case was a man age 69 years with newly diagnosed nonvalvular atrial fibrillation and no contraindications to warfarin therapy.Time Horizon: Lifetime.Perspective: Societal.Intervention: Genotype-guided dosing consisting of genotyping for CYP2C9*2, CYP2C9*3, and/or VKORC1 versus standard warfarin induction.Outcome Measures: Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were in 2007 U. S. dollars.Results: In the base case, genotype-guided dosing resulted in better outcomes, but at a relatively high cost. Overall, the marginal cost-effectiveness of testing exceeded $170 000 per QALY. On the basis of current data and cost of testing (about $ 400), there is only a 10% chance that genotype-guided dosing is likely to be cost-effective (that is,