Cost–effectiveness of pharmacogenetics in anticoagulation: international differences in healthcare systems and costs

Author:

Verhoef Talitha I1,Redekop William K2,van Schie Rianne MF1,Bayat Samira1,Daly Ann K3,Geitona Mary4,Haschke-Becher Elisabeth5,Hughes Dyfrig A6,Kamali Farhad3,Levin Lars-Åke7,Manolopoulos Vangelis G8,Pirmohamed Munir9,Siebert Uwe10,Stingl Julia C11,Wadelius Mia12,de Boer Anthonius1,Maitland-van der Zee Anke-Hilse13

Affiliation:

1. Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands

2. Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands

3. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK

4. School of Social Policy, University of Peloponnese, Corinth, Greece

5. Institute of Medical & Chemical Laboratory Diagnostics, Center of Molecular Diagnostics & Genetics, Elisabethinen Hospital Linz, Linz, Austria

6. Centre for Health Economics & Medicines Evaluation, Bangor University, North Wales, UK

7. Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden

8. Democritus University of Thrace, Alexandroupolis, Greece

9. University of Liverpool, Liverpool, UK

10. Department of Public Health & HTA, UMIT – University for Health Sciences, Medical Informatics & Technology, Hall i.T., Austria and ONCOTYROL – Center for Personalized Cancer Medicine, Innsbruck, Austria and Department of Health Policy & Management, Harvard School of Public Health, Boston, MA, USA and Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

11. Universität Ulm, Ulm, Germany

12. Department of Medical Sciences, Clinical Pharmacology, Uppsala University, Uppsala, Sweden

13. Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands.

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.

Publisher

Future Medicine Ltd

Subject

Pharmacology,Genetics,Molecular Medicine

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