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Purpose: Variants in CYP2C9 and VKORC1 genes have been associated with individuals' sensitivity to warfarin. The aim of this study was to investigate the differences of healthcare costs of genetically normal and genetically sensitive warfarin responder groups.

Methods: This was a retrospective study linking genotype data from three Finnish biobanks (THL Biobank, Auria Biobank, Helsinki Biobank) with healthcare encounter data of the Finnish Institute of Health and Welfare (THL), drug dispensation data from the Social Insurance Institution of Finland (Kela) and laboratory data from Finnish hospital districts and municipalities. We compared the normal and sensitive warfarin responder groups in terms of healthcare costs related to bleeding and thromboembolic events, INR tests and medication purchases.

Results: We found a trend towards increased bleeding-related hospital costs in the sensitive warfarin responder group (881 patients) when compared with the normal responders (1627 patients) with a per patient difference of 150.9 €/year (95% CI: -55.1, 414.6 €/year, p = 0.087). INR test costs were higher in the sensitive responder group with a difference of 7.2 €/year (95% CI: -1.5, 16.4 €/year, p = 0.047). Medication costs were significantly lower in the sensitive responder group with a difference of -14.4 €/year (95% CI: -15.8, -12.9 €/year, p < 0.001).

Conclusions: The difference in the costs of bleeding-related hospitalization between genetically sensitive and normal warfarin responders may justify genotype-guided warfarin dosing. Further studies with larger sample sizes would be needed to verify the result.

Titel:	Pharmacogenetics of warfarin and healthcare costs - Real-world data analysis.
Autor/in / Beteiligte Person:	Lähteenmäki, J ; Vuorinen, AL ; Lehto, M ; Niemi, M ; Forsberg, MM
Link:	Zum Volltext
Zeitschrift:	Pharmacoepidemiology and drug safety, Jg. 32 (2023-03-01), Heft 3, S. 382-386
Veröffentlichung:	Chichester, West Sussex : Wiley, 1992-, 2023
Medientyp:	academicJournal
ISSN:	1099-1557 (electronic)
DOI:	10.1002/pds.5585
Schlagwort:	Humans Pharmacogenetics Retrospective Studies Vitamin K Epoxide Reductases genetics Hemorrhage chemically induced Health Care Costs Data Analysis International Normalized Ratio Warfarin Anticoagulants
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Research Support, Non-U.S. Gov't Language: English [Pharmacoepidemiol Drug Saf] 2023 Mar; Vol. 32 (3), pp. 382-386. <i>Date of Electronic Publication: </i>2022 Dec 22. MeSH Terms: Warfarin* ; Anticoagulants* ; Humans ; Pharmacogenetics ; Retrospective Studies ; Vitamin K Epoxide Reductases / genetics ; Hemorrhage / chemically induced ; Health Care Costs ; Data Analysis ; International Normalized Ratio References: Lehto M, Niiranen J, Korhonen P, et al. Quality of warfarin therapy and risk of stroke, bleeding, and mortality among patients with atrial fibrillation: results from the nationwide FinWAF registry. Pharmacoepidemiol Drug Saf. 2017;26(6):657-665. doi:10.1002/pds.4194. ; Johnson JA, Cavallari LH. Warfarin pharmacogenetics. Trends Cardiovasc Med. 2015;25(1):33-41. doi:10.1016/j.tcm.2014.09.001. ; Pink J, Pirmohamed M, Lane S, Hughes DA. Cost-effectiveness of pharmacogenetics-guided warfarin therapy vs. alternative anticoagulation in atrial fibrillation. Clin Pharmacol Ther. 2014;95(2):199-207. doi:10.1038/CLPT.2013.190. ; Zhu Y, Swanson KM, Rojas RL, et al. Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases. Genet Med. 2019;22(3):475-486. doi:10.1038/s41436-019-0667-y. ; Verbelen M, Weale ME, Lewis CM. Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet? Pharmacogenomics J. 2017;17(5):395-402. doi:10.1038/tpj.2017.21. ; Stergiopoulos K, Brown DL. Genotype-guided vs clinical dosing of warfarin and its analogues: meta-analysis of randomized clinical trials. JAMA Intern Med. 2014;174(8):1330-1338. doi:10.1001/JAMAINTERNMED.2014.2368. ; Billings J, Racsa PN, Bordenave K, Long CL, Ellis JJ. The impact of real-world cardiovascular-related pharmacogenetic testing in an insured population. Int J Clin Pract. 2018;72(6):e13088. doi:10.1111/ijcp.13088. ; Sund R. Quality of the Finnish hospital discharge register: a systematic review. Scand J Public Health. 2012;40(6):505-515. doi:10.1177/1403494812456637. ; Vuorinen A-L, Lehto M, Niemi M, et al. Pharmacogenetics of anticoagulation and clinical events in warfarin-treated patients: a register-based cohort study with biobank data and National Health Registries in Finland. Clin Epidemiol. 2021;13:183-195. doi:10.2147/CLEP.S289031. ; Lähteenmäki J, Vuorinen A-L, Pajula J, et al. Integrating data from multiple Finnish biobanks and national health-care registers for retrospective studies: practical experiences. Scand J Public Health. 2021;50(4):482-489. doi:10.1177/14034948211004421. ; Kurki MI, Karjalainen J, Palta P, et al. FinnGen: unique genetic insights from combining isolated population and national health register data. medRxiv. 2022. doi:10.1101/2022.03.03.22271360. ; Mega JL, Walker JR, Ruff CT, et al. Genetics and the clinical response to warfarin and edoxaban: findings from the randomised, double-blind ENGAGE AF-TIMI 48 trial. Lancet. 2015;385(9984):2280-2287. doi:10.1016/S0140-6736(14)61994-2. ; Swanson KM, Zhu Y, Rojas RL, et al. Comparing outcomes and costs among Warfarin-sensitive patients versus warfarin-insensitive patients using the right drug, right dose, right time: using genomic data to individualize treatment (RIGHT) 10K Warfarin Cohort. PLoS One. 2020;15(5). doi:10.1371/JOURNAL.PONE.0233316. ; Leminen A, Pyykönen M, Tynkkynen J, Tykkyläinen M, Laatikainen T. Modeling patients' time, travel, and monitoring costs in anticoagulation management: societal savings achievable with the shift from warfarin to direct oral anticoagulants. BMC Health Serv Res. 2019;19(1):901. doi:10.1186/s12913-019-4711-z. ; Davison AC, Hinkley DV. Bootstrap Methods and their Application. Cambridge University Press; 1997. Contributed Indexing: Keywords: CYP2C9; INR; VKORC1; bleeding; healthcare costs; pharmacogenomics; warfarin Substance Nomenclature: 5Q7ZVV76EI (Warfarin) ; 0 (Anticoagulants) ; EC 1.17.4.4 (Vitamin K Epoxide Reductases) ; EC 1.17.4.4 (VKORC1 protein, human) Entry Date(s): Date Created: 20221216 Date Completed: 20230216 Latest Revision: 20230309 Update Code: 20240513

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Pharmacogenetics of warfarin and healthcare costs - Real-world data analysis.