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Cost-Effectiveness Analysis of Pharmacogenomics (PGx)-Based Warfarin, Apixaban, and Rivaroxaban Versus Standard Warfarin for the Management of Atrial Fibrillation in Ontario, Canada

Author

Listed:
  • Aneeka Hafeez

    (Western University)

  • Lauren E. Cipriano

    (Western University
    Western University)

  • Richard B. Kim

    (Western University
    Western University)

  • Gregory S. Zaric

    (Western University
    Western University)

  • Ute I. Schwarz

    (Western University
    Western University)

  • Sisira Sarma

    (Western University
    ICES (formerly the Institute for Clinical Evaluative Sciences))

Abstract

Objective To assess the cost-effectiveness of pharmacogenomics (PGx)-based warfarin (i.e., warfarin dosing following genetic testing), apixaban, and rivaroxaban oral anticoagulation versus standard warfarin for the treatment of newly diagnosed patients with nonvalvular atrial fibrillation (AF) aged ≥ 65 years. Methods We developed a Markov decision-analytic model to compare costs [2017 Canadian dollars (C$)] and quality-adjusted life years (QALYs) from the Ontario health care payer perspective over a life-time horizon. The parameters used in the model were derived from the published literature, the Ontario health care administrative database, and expert opinion. To account for the uncertainty of model parameters, we conducted extensive deterministic and probabilistic sensitivity analyses. The results were summarized using incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. Results We found that PGx-based warfarin had an ICER of C$17,584/QALY compared with standard warfarin, and apixaban had an ICER of C$64,590/QALY compared with PGx-based warfarin in our base-case analysis. Rivaroxaban was extendedly dominated by PGx-based warfarin and apixaban. The probabilistic sensitivity analysis showed that apixaban, rivaroxaban, PGx-based warfarin, and standard warfarin were cost-effective at some willingness-to-pay (WTP) thresholds. PGx-based warfarin had a higher probability of being cost-effective than apixaban (51.3% versus 14.3%) at a WTP threshold of C$50,000/QALY. At a WTP threshold of C$100,000/QALY, apixaban had a higher probability of being cost-effective than PGx-based warfarin (54.6% versus 22.6%). Conclusion We found that PGx-based warfarin for patients with AF is cost-effective at a WTP threshold of C$50,000/QALY. Apixaban had a higher probability of being cost-effective (> 50%) at a WTP threshold of C$93,000/QALY.

Suggested Citation

  • Aneeka Hafeez & Lauren E. Cipriano & Richard B. Kim & Gregory S. Zaric & Ute I. Schwarz & Sisira Sarma, 2024. "Cost-Effectiveness Analysis of Pharmacogenomics (PGx)-Based Warfarin, Apixaban, and Rivaroxaban Versus Standard Warfarin for the Management of Atrial Fibrillation in Ontario, Canada," PharmacoEconomics, Springer, vol. 42(1), pages 69-90, January.
    • Handle: RePEc:spr:pharme:v:42:y:2024:i:1:d:10.1007_s40273-023-01309-z
    DOI: 10.1007/s40273-023-01309-z
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    References listed on IDEAS

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    1. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    2. Charles Okafor & Joshua Byrnes & Simon Stewart & Paul Scuffham & Clifford Afoakwah, 2023. "Cost Effectiveness of Strategies to Manage Atrial Fibrillation in Middle- and High-Income Countries: A Systematic Review," PharmacoEconomics, Springer, vol. 41(8), pages 913-943, August.
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