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Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden

The Pharmacogenomics Journal volume 16, pages 478–484 (2016)Cite this article

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Abstract

We aimed to assess the cost-effectiveness of pharmacogenetic-guided dosing of warfarin in patients with atrial fibrillation (AF) in the United Kingdom and Sweden. Data from EU-PACT, a randomized controlled trial in newly diagnosed AF patients, were used to model the incremental costs per quality-adjusted life-year (QALY) gained by pharmacogenetic-guided warfarin dosing versus standard treatment over a lifetime horizon. Incremental lifetime costs were £26 and 382 Swedish kronor (SEK) and incremental QALYs were 0.0039 and 0.0015 in the United Kingdom and Sweden, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were £6 702 and 253 848 SEK per QALY gained. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 93% of the simulations in the United Kingdom and below 500 000 SEK in 67% of the simulations in Sweden. Our data suggest that pharmacogenetic-guided dosing of warfarin is a cost-effective strategy to improve outcomes of patients with AF treated with warfarin in the United Kingdom and in Sweden.

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Author information

Authors and Affiliations

  1. Department of Applied Health Research, University College London, London, UK

    T I Verhoef

  2. Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands

    T I Verhoef & A-H Maitland-van der Zee

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

    W K Redekop

  4. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    S Langenskiold

  5. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden

    S Langenskiold

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

    F Kamali

  7. Department of Medical Sciences, Clinical Pharmacology, and Science for Life Laboratory Uppsala University, Uppsala, Sweden

    M Wadelius

  8. Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    G Burnside & M Pirmohamed

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

    D A Hughes

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  1. T I Verhoef
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Corresponding author

Correspondence to M Pirmohamed.

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Competing interests

This work was supported by the European Community's Seventh Framework Programme under grant agreement HEALTH-F2-2009-223062. Dr Verhoef, Dr Maitland-van der Zee, Dr Wadelius and Dr Pirmohamed report grants from EU Commission FP7 programme, during the conduct of the study; Dr Wadelius reports grants from the Swedish Research Council (Medicine), grants from the Swedish Heart and Lung Foundation, grants from the Clinical Research Support at Uppsala University, during the conduct of the study; Dr Pirmohamed is an NIHR Senior Investigator; and as part of the EU-PACT trial, we worked with LGC (a UK-based company) who were a partner on the project, and developed the point-of-care platform which was used for genotyping in the trial, and on which the results of this cost-effectiveness paper are based. However, we did not receive any funding directly from LGC.

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Verhoef, T., Redekop, W., Langenskiold, S. et al. Cost-effectiveness of pharmacogenetic-guided dosing of warfarin in the United Kingdom and Sweden. Pharmacogenomics J 16, 478–484 (2016). https://doi.org/10.1038/tpj.2016.41

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