Genotype-Guided Warfarin Dosing: Is It Cost-Effective?

Costs would be above society’s willingness-to-pay threshold unless the approach could prevent at least a third of bleeding events in patients with nonvalvular atrial fibrillation.

The considerable variation in patient sensitivity to warfarin is attributed in part to mutations in genes that govern metabolism of this anticoagulant agent and its target, vitamin K epoxide reductase (JW Oncol Hematol Apr 1 2008). One third of this variation in sensitivity arises from mutations in two genes: CYP2C9 (which encodes cytochrome P450:2C9) and VKORC1 (which encodes vitamin K epoxide reductase C1). Individuals with CYP2C9 mutations have diminished ability to metabolize warfarin, and those with VKORC1 group A haplotype have excess sensitivity to warfarin-induced inhibition. Heightened warfarin sensitivity is associated with greater difficulty in maintaining prothrombin times within the therapeutic range and with excess risk for bl…

Reviewing Author

David Green, MD, PhD

Disclosures

EquityNovartis

David Green, MD, PhD

Disclosures

EquityNovartis