Navigation Links
Genetic testing not cost-effective in guiding initial dosing of common blood thinner

CINCINNATINew analyses led by the University of Cincinnati (UC) show that genetic testing used to guide initial dosing of the blood-thinner warfarin may not be cost-effective for typical patients with atrial fibrillation but may be for patients at higher risk for major bleeding.

This study is being published in the Jan. 20, 2009, edition of Annals of Internal Medicine.

Warfarin is commonly prescribed to prevent blood clotting, particularly for patients with atrial fibrillationa type of abnormal heart rhythm.

Mark Eckman, MD, professor of medicine at UC and lead investigator of the study, says the U.S. Food and Drug Administration changed the labeling for warfarin in 2007, suggesting that clinicians consider genetic testing before initiating therapy.

"There are certain genes that are known to contribute to an increased sensitivity to warfarin," he says. "The idea behind genetic testingalso known as pharmacogenetic-guided dosing is to help guide the initial, and possibly lower, dose of warfarin for patients found to possess certain variants of the genes cytochrome P450 CYP2C9 and vitamin K epoxide reductase, or VKORC1. The hope is that more accurate dosing will translate into decreased major bleeds during the initiation phase of warfarin dosing, which is the first month or so."

Eckman says the study looked at whether the benefit of testing is worth the costs associated with it.

Researchers first performed an analysis combining the results of the only three clinical studies published to date to determine the degree to which pharmacogenetic-guided dosing decreases the risk of major bleeds when compared with standard induction of treatment with warfarin.

The team next constructed a model to estimate the cost-effectiveness of a genotype-guided dosing strategy.

While they found that genotype-guided dosing resulted in better outcomes, it was at a relatively high costover $170,000 per quality-adjusted life year gained.

In other analyses, where they took into consideration the limitations of the studies, researchers found that there is only a 10 percent chance that genotype-guided dosing is likely to be cost-effective.

Researchers also looked at the impact of other variables on the cost-effectiveness of genotype-guided dosing.

Eckman says results show that genotype-guided dosing might be worth the costs if it:

  • Is used for patients at high risk for hemorrhage
  • Prevents more than 32 percent of major bleeding events
  • Is available within 24 hours
  • Costs less than $200

"This could be accomplished if testing were done in-house, at lower cost and without delays," he says, noting that currently in most cases these tests need to be sent to outside laboratories which can lead to delays in starting treatment and increased cost. "Furthermore, future studies, such as the recently funded National Institutes of Health COAG trial, need to examine the impact of pharmacogenetic-guided dosing on bleeding risk and monitor outcomes long enough to determine the true duration of benefit."

Eckman also suggests that rather than excluding patients at higher risk for bleeding, studies should offer enrollment if it has already been determined that these patients require warfarin.

"Personalized, predictive medicine offers great promise, but we need to carefully examine the benefits and understand the cost-effectiveness of such strategies before we spend a lot of money on very expensive tests."


Contact: Katie Pence
University of Cincinnati

Related biology news :

1. Rethinking the genetic theory of inheritance
2. Biologist enhances use of bioinformatic tools and achieves precision in genetic annotation
3. MUHC and McGill scientists explain genetic disease first discovered in Quebec 24 years ago
4. New drug holds out promise of normal diet for sufferers of devastating PKU genetic disease
5. Growth of new brain cells requires epigenetic switch
6. Studies examine genetic determinants of ADHD
7. Genetic mutation causes familial susceptibility for degenerative brain disease
8. New genetic markers for ulcerative colitis identified, researchers report in Nature Genetics
9. Genetic variation may lead to early cardiovascular disease
10. Scientists make strides toward defining genetic signature of Alzheimers disease
11. Safe new therapy for genetic heart disease
Post Your Comments:
(Date:11/18/2015)... ALBANY, New York , November 18, 2015 /PRNewswire/ ... Transparency Market Research has published a new market report ... Share, Growth, Trends, and Forecast, 2015 - 2021. According to ... bn in 2014 and is anticipated to reach US$29.1 ... 2015 to 2021. North America ...
(Date:11/16/2015)... 2015  Synaptics Inc. (NASDAQ: SYNA ), ... announced expansion of its TDDI product portfolio with ... and display driver integration (TDDI) solutions designed to ... TDDI products add to the previously-announced TD4300 ... resolution), and TD4322 (FHD resolution) solutions. All four ...
(Date:11/10/2015)... Nov. 10, 2015  In this report, ... basis of product, type, application, disease indication, ... this report are consumables, services, software. The ... safety biomarkers, efficacy biomarkers, and validation biomarkers. ... are diagnostics development, drug discovery and development, ...
Breaking Biology News(10 mins):
(Date:11/24/2015)... 2015  Asia-Pacific (APAC) holds the third-largest share ... The trend of outsourcing to low-cost locations is ... volume share for the region in the short ... in the CRO industry will improve. ... ), finds that the market earned revenues ...
(Date:11/24/2015)... SUNNYVALE, Calif. , Nov. 24, 2015 ... executives will be speaking at the following conference, and ... New York, NY      Tuesday, December 1, ... New York, NY      Tuesday, December 1, ...      Piper Jaffray Healthcare Conference, New York, NY ...
(Date:11/24/2015)... 24, 2015 /CNW/ - iCo Therapeutics ("iCo" or "the ... results for the quarter ended September 30, 2015. ... dollars and presented under International Financial Reporting Standards ... ," said Andrew Rae , President & ... are not only value enriching for this clinical ...
(Date:11/24/2015)... ... November 24, 2015 , ... International Society for Pharmaceutical ... the premier annual events for pharmaceutical manufacturing: 2015 Annual Meeting. The conference took ... hosted the largest number of attendees in more than a decade. , ...
Breaking Biology Technology: