Pharmacoeconomic evaluation of warfarin pharmacogenomics

INTRODUCTION: the merit of applying pharmacogenomics in the induction phase of warfarin therapy for personalized dosing is controversial and highly dependent on its cost-effectiveness. AREAS COVERED: published studies on pharmacoeconomics of warfarin pharmacogenomic application are reviewed. A literature search was done using Medline and Embase covering the period 2000 - 2010. Decision tree and Markov modeling were the most frequently used methods in the reviewed reports. Studies incorporating clinical efficacy data of genotype-guided dosing algorithm had shown that warfarin pharmacogenomics would improve quality-adjusted life-years (QALYs) gained. Nevertheless, it was unlikely to be cost-effective for general patients. Influential factors to improve the cost-effectiveness included low genotyping cost, high effectiveness in improving anticoagulation control/event rate, and applying warfarin pharmacogenomics to patients with high bleeding risk or at practice sites with suboptimal management of anticoagulation control. EXPERT OPINION: warfarin pharmacogenomics would improve QALYs and could possibly be cost-effective in selected patient groups or practice sites.