Evidence map›Paper›PMID 20031873›Full record

ArticleCirculation. Cardiovascular quality and outcomes2009

Cost-effectiveness of genotype-guided warfarin dosing for patients with atrial fibrillation.

Amanda R Patrick, Jerry Avorn, Niteesh K Choudhry

Abstract read
PubMed Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 9 pooled it
43.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 9 syntheses or guidelines pooled it, 110 citations in OpenAlex.

  1. Pooled it
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  3. Systematic review of the evidence on the cost-effectiveness of pharmacogenomics-guided treatment for cardiovascular diseases.Genetics in medicine : official journal of the American College of Medical Genetics · 2020
    Pooled it
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  8. Guideline
  9. Pooled it
  10. Trial
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  12. De-risking Atrial Fibrillation: Refining Anticoagulation Decision-Making.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026
    Review
  13. Article
  14. Review
  15. Article
  16. Optimizing quality care for the oral vitamin K antagonists (VKAs).Hematology. American Society of Hematology. Education Program · 2018
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

Amanda R PatrickDivision of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. arpatrick@partners.org
Jerry Avorn
Niteesh K Choudhry
Brigham and Women's Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCYP2C9 and VKORC1 genotyping has been advocated as a means of improving the accuracy of warfarin dosing. However, the effectiveness of genotyping in improving anticoagulation control and reducing major bleeding has not yet been compellingly demonstrated. Genotyping currently costs $400 to $550. METHODS AND

resultsWe constructed a Markov model to evaluate whether and under what circumstances genetically-guided warfarin dosing could be cost-effective for newly diagnosed atrial fibrillation patients. Estimates of clinical event rates, treatment and adverse event costs, and utilities for health states were derived from the published literature. The cost-effectiveness of genetically-guided dosing was highly dependent on the assumed effectiveness of genotyping in increasing the amount of time patients spend appropriately anticoagulated. If genotyping increases the time spent in the target international normalized ratio range by <5 percentage points, its incremental cost-effectiveness ratio would be greater than $100,000 per quality-adjusted life year. The incremental cost-effectiveness ratio falls below $50,000 per quality-adjusted life year if genotyping increases the time spent in range by 9 percentage points. The results were also sensitive to assumptions about the rate of major bleeding events during treatment initiation and the cost of the test.

conclusionsOur results suggest that genotyping before warfarin initiation will be cost-effective for patients with atrial fibrillation only if it reduces out-of-range international normalized ratio values by more than 5 to 9 percentage points compared with usual care. Given the current uncertainty surrounding genotyping efficacy, caution should be taken in advocating the widespread adoption of this strategy.

Indexed as

AgedAnticoagulantsAryl Hydrocarbon HydroxylasesAtrial FibrillationBrain IschemiaCost-Benefit AnalysisCytochrome P-450 CYP2C9Drug CostsGenetic TestingGenotypeHemorrhageHumansIncidenceMarkov ChainsMixed Function OxygenasesModels, EconometricAnticoagulantsAryl Hydrocarbon HydroxylasesCYP2C9 protein, humanCytochrome P-450 CYP2C9Mixed Function OxygenasesVitamin K Epoxide ReductasesVKORC1 protein, humanWarfarin

Identifiers

PMID20031873
OpenAlexW2116333054

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.