PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: This study aims to evaluate the utilities and cost-effectiveness of pharmacogenomics-guided versus standard dosing of warfarin in patients with MPHV in Iran.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: This study aims to evaluate the utilities and cost-effectiveness of pharmacogenomics-guided versus standard dosing of warfarin in patients with MPHV in Iran.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■华法林是唯一被批准用于机械假体心脏瓣膜（MPHV）患者抗血栓治疗的抗凝剂。然而,服用华法林由于其狭窄的治疗窗口和高度可变的临床结果而具有挑战性。低剂量和高剂量华法林均可导致血栓形成和出血事件。分别,这些并发症在具有敏感遗传多态性的个体中更严重。结合基因检测可以提高华法林给药的准确性并最大程度地减少其不良事件。
■本研究旨在评估药物基因组学指导与标准剂量华法林在伊朗MPHV患者中的效用和成本效益。
■在这项经济评估研究中，进行了成本-效果分析,以比较药物基因组学指导与标准华法林给药.与生活质量（QoL）相关的数据是通过一项横断面研究收集的，该研究涉及105名随机选择的MPHV患者，使用EuroQol-5D（EQ-5D）问卷。根据临床专家的意见和相关指南的审查计算费用。从已发表的文献中提取其他临床数据。伊朗医疗系统内医疗干预措施的药物经济门槛为1,500美元。从伊朗医疗保健系统的角度设计了决策树模型，研究范围为一年。还进行了灵敏度分析以评估输入参数的不确定性。
■来自标准和药物基因组学指导的华法林治疗问卷的效用得分分别为0.68和0.76。与标准剂量相比，基因型指导剂量华法林的成本更高（$246vs$69），计算出的增量成本效益比(ICER)为每获得质量调整生命年(QALY)2474美元.单向敏感性分析表明，我们的模型对治疗范围内的时间百分比(PTTR)敏感，基因检测的费用,以及药物基因组学指导和标准给药臂的效用。然而,概率敏感性分析证明了我们模型的稳健性。
■使用药物基因组学测试给药华法林目前并不划算。然而,如果基因分型测试的成本降至118美元,ICER将具有成本效益.
■本研究旨在评估药物基因组学指导与标准剂量华法林在伊朗MPHV患者中的效用和成本效益。
■在这项经济评估研究中，进行了成本-效果分析,以比较药物基因组学指导与标准华法林给药.与生活质量（QoL）相关的数据是通过一项横断面研究收集的，该研究涉及105名随机选择的MPHV患者，使用EuroQol-5D（EQ-5D）问卷。根据临床专家的意见和相关指南的审查计算费用。从已发表的文献中提取其他临床数据。伊朗医疗系统内医疗干预措施的药物经济门槛为1,500美元。从伊朗医疗保健系统的角度设计了决策树模型，研究范围为一年。还进行了灵敏度分析以评估输入参数的不确定性。
■来自标准和药物基因组学指导的华法林治疗问卷的效用得分分别为0.68和0.76。与标准剂量相比，基因型指导剂量华法林的成本更高（$246vs$69），计算出的增量成本效益比(ICER)为每获得质量调整生命年(QALY)2474美元.单向敏感性分析表明，我们的模型对治疗范围内的时间百分比(PTTR)敏感，基因检测的费用,以及药物基因组学指导和标准给药臂的效用。然而,概率敏感性分析证明了我们模型的稳健性。
■使用药物基因组学测试给药华法林目前并不划算。然而,如果基因分型测试的成本降至118美元,ICER将具有成本效益.
