Cost-Effectiveness of Genetic Testing for Optimizing Warfarin Therapy in Mechanical Heart Valve Patients: Insights From Qatar
Author(s)
Dina Abushanab, PhD1, Shaban Mohammed, BSc1, Rania Abdellatif, PhD2, Touqa Hazzem, BSc3, Tamer Abdelghafour, MD3, Sameh Aboulnagah, MD3, Samy Hanoura, MD3, Yasser Shouman, MD3, Moza Al Hail, BSc1, Wadha Al-Muftah, BSc2, Said I. Ismail, BSc2, Amr Omar, MD3, Daoud Al-Badriyeh, PhD4.
1Hamad Medical Corporation, Doha, Qatar, 2Qatar Foundation, Doha, Qatar, 3Hamad Medical corporation, Doha, Qatar, 4Professor, College of Pharmacy, Qatar University, Doha, Qatar.
1Hamad Medical Corporation, Doha, Qatar, 2Qatar Foundation, Doha, Qatar, 3Hamad Medical corporation, Doha, Qatar, 4Professor, College of Pharmacy, Qatar University, Doha, Qatar.
OBJECTIVES: Patients with mechanical heart valve replacement (MHVR) require lifelong antithrombotic therapy, primarily with vitamin K antagonists like warfarin. The FDA now endorses genetic testing to individualize warfarin dosing, supported by guidelines from the Clinical Pharmacogenetics Implementation Consortium. This study aimed to evaluate the cost-effectiveness of pharmacogenetic testing (PGx) for warfarin dosing versus the standard of care (SoC) in patients with MHVR.
METHODS: From a public hospital perspective, we constructed a lifetime Markov model that utilizes weekly cycles. The analysis compared the current SoC with PGx-guided testing in patients with MHVR. Clinical outcomes and utility values were obtained from published studies, while healthcare costs were sourced from local Qatari sources. The incremental cost-effectiveness ratio was evaluated in terms of quality-adjusted life years (QALYs) gained and years of life lived.
RESULTS: The base-case analysis indicated that PGx-guided warfarin therapy could yield an additional 1,681 QALYs and save 1,009 life years compared to SoC. Total direct healthcare costs were projected at QAR21,521,081 for PGx-guided therapy versus QAR31,059,343 for SoC, resulting in a cost saving of QAR9,538,262 (3.64 QAR=1 USD). Sensitivity analyses confirmed that the overall cost savings remained stable across varying parameters, with PGx-guided testing deemed cost-saving in 74% of simulated cases.
CONCLUSIONS: The implementation of PGx-guided warfarin dosing demonstrates significant health benefits and cost savings for MHVR patients in Qatar. These findings provide critical evidence for decision-makers as they consider adopting PGx-guided therapies. Further research is warranted to refine the clinical properties of this approach.
METHODS: From a public hospital perspective, we constructed a lifetime Markov model that utilizes weekly cycles. The analysis compared the current SoC with PGx-guided testing in patients with MHVR. Clinical outcomes and utility values were obtained from published studies, while healthcare costs were sourced from local Qatari sources. The incremental cost-effectiveness ratio was evaluated in terms of quality-adjusted life years (QALYs) gained and years of life lived.
RESULTS: The base-case analysis indicated that PGx-guided warfarin therapy could yield an additional 1,681 QALYs and save 1,009 life years compared to SoC. Total direct healthcare costs were projected at QAR21,521,081 for PGx-guided therapy versus QAR31,059,343 for SoC, resulting in a cost saving of QAR9,538,262 (3.64 QAR=1 USD). Sensitivity analyses confirmed that the overall cost savings remained stable across varying parameters, with PGx-guided testing deemed cost-saving in 74% of simulated cases.
CONCLUSIONS: The implementation of PGx-guided warfarin dosing demonstrates significant health benefits and cost savings for MHVR patients in Qatar. These findings provide critical evidence for decision-makers as they consider adopting PGx-guided therapies. Further research is warranted to refine the clinical properties of this approach.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE252
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Personalized & Precision Medicine