Cost-Benefit Analysis of Genotype-Guided Interruption Days in Warfarin Pre-Procedural Management

Warfarin is commonly used in thromboem-bolic conditions. Warfarin interruption represents a significant challenge in pre-operative warfarin man-agement as it is associated with major consequences. Genetics polymorphism demonstrated to be a signifi-cant predictor of the required days of warfarin inter-ruption. This study sought to assess the economic benefit of implementing a pharmacogenetic-guided approach in the preprocedural warfarin management. From the hospital's perspective, a cost-benefit analysis was conducted based on a 1-year decision-analytic fol-low-up model of the economic implications of using a pharmacogenetic algorithm vs standard of care in pre-operative warfarin management in the Hamad Medi-cal Corporation, Qatar. The benefit of the interven-tional algorithm was based on estimated reduction in the probabilities of clinical events and their cost, added to the avoided cost because of canceled procedures. The cost of the algorithm was the cost of the genotyp-ing assay. The model event probability inputs were extracted from major literature clinical trials, and the setting-specifc and cost inputs were locally obtained. The model was based on a multivariate analysis at its base case. As per 10.3% prevalence of genetic variants, 82% bridging, and a calculated 20% optimization in the preparative period of warfarin management, the benefit to cost ratio was 4.0 in favor genotype-guided approach. This positive benefit to cost ratio was main-tained in 100% of the simulated study cases. Sensitiv-ity analyses confirmed the robustness and generalizability of the study conclusion. A pharmaco- genetic-guided pre-operative warfarin interruption management is a cost-beneficial approach in the Qatari practice.

Automated summary

The study assessed the economic benefit of using a pharmacogenetic-guided approach in preoperative warfarin management. The results showed that this approach is cost-beneficial, reducing medical costs and procedure cancellation rate.