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Figure 1. Model structure of the decision tree used to analyze the cost-effectiveness of pharmacogenetic-guided dosing versus standard care. Patients initiating treatment with phenprocoumon are classified according to treatment arm (pharmacogenetic-guided dosing or standard care) and stratified by genotype. The two arms are equal up to the Markov node. At this point, different chances of developing adverse events are defined. M: Markov nodes.
(Figure omitted. See article PDF.)
Figure 2. Markov model health states. All patients enter the model in the 'healthy + AF'state and can move to other states at monthly intervals. AF: Atrial fibrillation; TE: Thromboembolic event.
(Figure omitted. See article PDF.)
Figure 3. Percentage time spent in different International Normalized Ratio ranges during the first and sixth month of standard phenprocoumon treatment. VKORC1 genotype is shown (GG, AG, AA), as well as CYP2C9 genotype (WT or VAR). INR: International Normalized Ratio; VAR: Variant; WT: Wild-type.
(Figure omitted. See article PDF.)
Figure 4. Cumulative risk of adverse events in the first 12 months of treatment. (A) Bleeding event; (B) thromboembolism. PGx: Pharmacogenetic-guided dosing; TE: Thromboembolic event.
(Figure omitted. See article PDF.)
Figure 5. Tornado diagram showing the ten parameters with the largest influence on the cost-effectiveness ratio of pharmacogenetic-guided dosing versus standard care. The range of the incremental cost-effectiveness ratio in the one-way sensitivity analysis over the range of the parameter (in parentheses) is represented by the horizontal bars. A wide bar indicates that this parameter introduces a large degree of uncertainty. INR: International Normalized Ratio; TE: Thromboembolic event; QALY: Quality-adjusted life-year.
(Figure omitted. See article PDF.)
Figure 6. Scatter plot reflecting the uncertainty in the differences in costs and effectiveness between genotyping and standard care (based on probabilistic sensitivity analysis). QALY: Quality-adjusted life-year.
(Figure omitted. See article PDF.)
Figure 7. Cost-effectiveness acceptability curve. This curve, generated from the Monte Carlo simulations, represents the probability that pharmacogenetic-guided dosing would be cost effective compared with standard care at different thresholds of willingness-to-pay. QALY: Quality-adjusted life-year.
(Figure omitted. See article PDF.)
Coumarin derivatives are widely used anticoagulants, prescribed to treat and prevent thromboembolic events, in patients with, for example, atrial fibrillation [1,2]. Warfarin is the most commonly used coumarin, but in several European countries phenprocoumon or acenocoumarol are more frequently used [3]. Warfarin, acenocoumarol...