Benjamin P. Geisler, MD; Jeffrey K. Levin-Scherz, MD, MBA
Potential Financial Conflicts of Interest: None disclosed.
Geisler BP, Levin-Scherz JK. Additional Factors That Could Improve Cost-Effectiveness of Pharmacogenetic-Guided Dosing in Warfarin Therapy. Ann Intern Med. 2009;151:71. doi: 10.7326/0003-4819-151-1-200907070-00016
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Published: Ann Intern Med. 2009;151(1):71.
TO THE EDITOR:
We were surprised that Eckman and colleagues (1) found through comprehensive modeling that genotyping before warfarin therapy instead of standard care without genotyping is not cost effective compared with other, well-accepted medical interventions.
We suggest that additional factors may improve the cost-effectiveness of warfarin genotyping. For example, if patients with a short-term warfarin indication (that is, uncomplicated deep venous thrombosis) had their genotype recorded in an interoperable electronic health record, this test would not need to be repeated before subsequent warfarin use. Because genotype testing is the largest component of costs, additional benefit would accrue with limited or no incremental costs. In addition, restricting testing to persons most likely to have complications of supratherapeutic warfarin levels (that is, elderly persons at high risk for falls or patients with a known history of gastrointestinal bleeding) may improve cost-effectiveness. The incremental costs of avoiding complications may be lower and the incremental health benefits may be higher.
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