Cost-Effectiveness Analysis of Pharmacogenomics-Guided Versus Standard Dosing of Warfarin in Patients with Mechanical Prosthetic Heart Valve

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AuthorHoma Hematien
AuthorMarzieh Nosratien
AuthorMandana Hasanzaden
AuthorParham Rahmanien
AuthorSoroush Farimanen
AuthorMohadese Sarabien
AuthorSepideh Shirvanien
AuthorParham Sadeghipouren
AuthorShekoufeh Nikfaren
OrcidHoma Hemati [0000-0002-8704-2144]en
OrcidMarzieh Nosrati [0000-0001-8964-1653]en
OrcidMandana Hasanzad [0000-0002-0538-1135]en
OrcidSoroush Fariman [0000-0002-6193-9578]en
OrcidParham Sadeghipour [0000-0001-9602-0513]en
OrcidShekoufeh Nikfar [0000-0002-5206-6197]en
Issued Date2024-12-31en
AbstractBackground: Warfarin is the only approved anticoagulant for antithrombotic treatment in patients with mechanical prosthetic heart valves (MPHV). However, dosing warfarin is challenging due to its narrow therapeutic window and highly variable clinical outcomes. Both low and high doses of warfarin can lead to thrombotic and bleeding events, respectively, with these complications being more severe in individuals with sensitive genetic polymorphisms. Incorporating genetic testing could enhance the accuracy of warfarin dosing and minimize its adverse events. Objectives: This study aims to evaluate the utilities and cost-effectiveness of pharmacogenomics-guided versus standard dosing of warfarin in patients with MPHV in Iran. Methods: In this economic evaluation study, a cost-effectiveness analysis was conducted to compare pharmacogenomics-guided versus standard warfarin dosing. Data related to quality of life (QoL) were collected through a cross-sectional study involving 105 randomly selected MPHV patients using the EuroQol-5D (EQ-5D) Questionnaire. Costs were calculated with input from clinical experts and a review of relevant guidelines. Additional clinical data were extracted from published literature. The pharmacoeconomic threshold set for medical interventions within Iran's healthcare system was $1,500. A decision tree model was designed from the perspective of Iran's healthcare system with a one-year study horizon. Sensitivity analyses were also performed to assess the uncertainty of input parameters. Results: The utility scores derived from the questionnaire for standard and pharmacogenomics-guided warfarin treatments were 0.68 and 0.76, respectively. Genotype-guided dosing of warfarin was more costly compared to the standard dosing ($246 vs $69), and the calculated incremental cost-effectiveness ratio (ICER) was $2474 per quality-adjusted life year (QALY) gained. One-way sensitivity analyses showed that our model is sensitive to the percentage of time in the therapeutic range (PTTR), the cost of genetic tests, and the utility of both pharmacogenomics-guided and standard dosing arms. However, the probabilistic sensitivity analysis demonstrates the robustness of our model. Conclusions: Warfarin dosing with pharmacogenomics testing is currently not cost-effective. However, if the cost of genotyping tests decreases to $118, the ICER would become cost-effective.en
DOIhttps://doi.org/10.5812/ijpr-143898en
KeywordPharmacogenomicsen
KeywordPrecision Medicineen
KeywordQuality-Adjusted Life Yearen
KeywordHeart Valveen
KeywordPharmacoeconomicsen
KeywordCardiovascular Diseaseen
KeywordEconomic Evaluationen
KeywordWarfarinen
KeywordCost Effectivenessen
PublisherBrieflandsen
TitleCost-Effectiveness Analysis of Pharmacogenomics-Guided Versus Standard Dosing of Warfarin in Patients with Mechanical Prosthetic Heart Valveen
TypeResearch Articleen

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