D. Kim,1 M. Oh,1 H. Kim,1 J. Shin2; 1Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Korea, Republic of, 2Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine; Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Korea, Republic of
BACKGROUND: There was no report on cost effectiveness of genotype-guided warfarin dosing in patients with mechanical heart valve replacement (MHVR) who receive initial warfarin during hospitalization and different quality of life with other patients. In addition, no report has been found under Fee-For-Service system not Diagnosis-Related Group system. The aim of this study was to evaluate the cost-effectiveness of genotype-guided warfarin dosing vs. standard warfarin dosing in patients with mechanical heart valve replacement under Fee-For-Service system.
METHODS: A decision-analytic Markov model was developed to evaluate the cost-effectiveness of genotype-guided warfarin dosing vs. standard warfarin dose. Estimates of clinical event rates and utilities for health states were derived from published literature and estimates of healthcare costs from public source of Korean Health Insurance Service and Health Insurance Review & Assessment service ($ USD; year 2012 values). Outcome measure was incremental cost-effectiveness ratios (ICER) per quality-adjusted life-year (QALY) gained from societal perspective. One-way sensitivity analyses were performed to explore the range of plausible results.
RESULTS: In base-case analysis, genotype-guided warfarin dosing gained higher QALYs than standard warfarin dosing (5.72 QALYs vs. 5.69 QALYs) at lower cost ($7906.38 vs. $8198.97) with ICER = $-10493.62. In sensitivity analysis, the cost-effectiveness of genotype-guided warfarin dosing was most affected by its effect on reducing time to reach stable anticoagulation.
CONCLUSION: Our results suggest that genotype-guided warfarin dosing will be cost-effective for patients with MHVR under Korean healthcare system.