Joyce H S You1. 1. School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China SAR.
Abstract
AIM: This study aims to compare clinical and economic outcomes of CYP2C9 and VKORC1 genotype-guided (PG-DOAC) versus universal use of direct oral anticoagulant (DOAC) for stroke prevention in patients with atrial fibrillation (AF). METHODS: Outcomes of oral anticoagulation therapy were simulated using life-long Markov modeling. In PG-DOAC, patients with genotype of high or low warfarin sensitivity were treated with DOAC, and patients with normal warfarin sensitivity genotype received warfarin. RESULTS: Expected quality-adjusted life-years (QALYs) and cost of DOAC were higher than PG-DOAC. Incremental cost per QALY (ICER) of DOAC versus PG-DOAC was 314,129 USD/QALY, exceeding willingness-to-pay threshold (50,000 USD/QALY). CONCLUSION: Using individual genotype to guide the use of DOAC versus warfarin appears to be the preferred strategy.
AIM: This study aims to compare clinical and economic outcomes of CYP2C9 and VKORC1 genotype-guided (PG-DOAC) versus universal use of direct oral anticoagulant (DOAC) for stroke prevention in patients with atrial fibrillation (AF). METHODS: Outcomes of oral anticoagulation therapy were simulated using life-long Markov modeling. In PG-DOAC, patients with genotype of high or low warfarin sensitivity were treated with DOAC, and patients with normal warfarin sensitivity genotype received warfarin. RESULTS: Expected quality-adjusted life-years (QALYs) and cost of DOAC were higher than PG-DOAC. Incremental cost per QALY (ICER) of DOAC versus PG-DOAC was 314,129 USD/QALY, exceeding willingness-to-pay threshold (50,000 USD/QALY). CONCLUSION: Using individual genotype to guide the use of DOAC versus warfarin appears to be the preferred strategy.
Authors: Ye Zhu; Kristi M Swanson; Ricardo L Rojas; Zhen Wang; Jennifer L St Sauver; Sue L Visscher; Larry J Prokop; Suzette J Bielinski; Liewei Wang; Richard Weinshilboum; Bijan J Borah Journal: Genet Med Date: 2019-10-08 Impact factor: 8.822
Authors: Justin B Kaye; Lauren E Schultz; Heidi E Steiner; Rick A Kittles; Larisa H Cavallari; Jason H Karnes Journal: Pharmacotherapy Date: 2017-09-06 Impact factor: 4.705