Additional Factors That Could Improve Cost-Effectiveness of Pharmacogenetic-Guided Dosing in Warfarin Therapy
Authors: Mark H. Eckman
Journal: Annals of Internal Medicine (2009)

Letters7 July 2009Additional Factors That Could Improve Cost-Effectiveness of Pharmacogenetic-Guided Dosing in Warfarin TherapyMark H. Eckman, MD, MS, Jonathan Rosand, MD, MSc, Steven M. Greenberg, MD, PhD, and Brian F. Gage, MD, MScMark H. Eckman, MD, MSFrom University of Cincinnati, Cincinnati, OH 45267; Massachusetts General Hospital, Boston, MA 02114; and Washington University, St. Louis, MO 63110.Search for more papers by this author, Jonathan Rosand, MD, MScFrom University of Cincinnati, Cincinnati, OH 45267; Massachusetts General Hospital, Boston, MA 02114; and Washington University, St. Louis, MO 63110.Search for more papers by this author, Steven M. Greenberg, MD, PhDFrom University of Cincinnati, Cincinnati, OH 45267; Massachusetts General Hospital, Boston, MA 02114; and Washington University, St. Louis, MO 63110.Search for more papers by this author, and Brian F. Gage, MD, MScFrom University of Cincinnati, Cincinnati, OH 45267; Massachusetts General Hospital, Boston, MA 02114; and Washington University, St. Louis, MO 63110.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-1-200907070-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the comments of Drs. Geisler and Levin-Scherz and agree with many of their observations. The results of our analysis are more nuanced than a simple assertion that pharmacogenetic-guided dosing is not cost effective. Indeed, we used sensitivity analyses to explore how changes in either health care delivery systems or patient characteristics might affect the cost-effectiveness of pharmacogenetic-guided dosing. With regard to systems changes that might make this strategy cost-effective, we found that the marginal cost-effectiveness ratio drops below a societal willingness-to-pay threshold of $50 000 per quality-adjusted life-year when the cost of genotyping is less than $200 ...Reference1. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151:713-9. [PMID: 16504638] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mark H. Eckman, MD, MS; Jonathan Rosand, MD, MSc; Steven M. Greenberg, MD, PhD; Brian F. Gage, MD, MScAffiliations: From University of Cincinnati, Cincinnati, OH 45267; Massachusetts General Hospital, Boston, MA 02114; and Washington University, St. Louis, MO 63110.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Using Pharmacogenetic Information in Warfarin Dosing for Patients With Nonvalvular Atrial Fibrillation Mark H. Eckman , Jonathan Rosand , Steven M. Greenberg , and Brian F. Gage Additional Factors That Could Improve Cost-Effectiveness of Pharmacogenetic-Guided Dosing in Warfarin Therapy Benjamin P. Geisler and Jeffrey K. Levin-Scherz Metrics 7 July 2009Volume 151, Issue 1Page: 71KeywordsAdverse eventsConflicts of interestForecastingGenotypingHealth careHemorrhageMedical risk factorsQuality adjusted life yearsRandomized trialsRelative risk ePublished: 7 July 2009 Issue Published: 7 July 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...