Cost Effectiveness of Genotype-Guided Warfarin Dosing in Patients with Mechanical Heart Valve Replacement Under the Fee-for-Service System

Dong-Jin Kim, Ho-Sook Kim (), Minkyung Oh, Eun-Young Kim and Jae-Gook Shin ()
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Dong-Jin Kim: Inje University College of Medicine
Ho-Sook Kim: Inje University College of Medicine
Minkyung Oh: Inje University College of Medicine
Eun-Young Kim: Inje University College of Medicine
Jae-Gook Shin: Inje University College of Medicine

Applied Health Economics and Health Policy, 2017, vol. 15, issue 5, No 11, 657-667

Abstract: Abstract Background Although studies assessing the cost effectiveness of genotype-guided warfarin dosing for the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolism have been reported, no publications have addressed genotype-guided warfarin therapy in mechanical heart valve replacement (MHVR) patients or genotype-guided warfarin therapy under the fee-for-service (FFS) insurance system. Objective The aim of this study was to evaluate the cost effectiveness of genotype-guided warfarin dosing in patients with MHVR under the FFS system from the Korea healthcare sector perspective. Methods A decision-analytic Markov model was developed to evaluate the cost effectiveness of genotype-guided warfarin dosing compared with standard dosing. Estimates of clinical adverse event rates and health state utilities were derived from the published literature. The outcome measure was the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY). One-way and probabilistic sensitivity analyses were performed to explore the range of plausible results. Results In a base-case analysis, genotype-guided warfarin dosing was associated with marginally higher QALYs than standard warfarin dosing (6.088 vs. 6.083, respectively), at a slightly higher cost (US$6.8) (year 2016 values). The ICER was US$1356.2 per QALY gained. In probabilistic sensitivity analysis, there was an 82.7% probability that genotype-guided dosing was dominant compared with standard dosing, and a 99.8% probability that it was cost effective at a willingness-to-pay threshold of US$50,000 per QALY gained. Conclusion Compared with only standard warfarin therapy, genotype-guided warfarin dosing was cost effective in MHVR patients under the FFS insurance system.

Keywords: Warfarin; International Normalize Ratio; Warfarin Therapy; Warfarin Dose; Probabilistic Sensitivity Analysis (search for similar items in EconPapers)
Date: 2017
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DOI: 10.1007/s40258-017-0317-y

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