Genetic warfarin test not cost-effective in guiding initial dosing of common blood thinner
Posted Jan 22 2009 5:14pm
We want personalized medicine to move forward, but now we are back to the same question, who’s going to pay for the Warfarin Test? As just the opposite is occurring in the UK from a prior post. They want folks to have the test.
London has taken a pioneering step into the world of personalized medicine, opening a hospital clinic that will decipher an individual's genetic code to determine their dose of a blood-thinning drug
Well are we worth saving and improving our lives with the information? It appears the jury is still out, as CMS still has not decided either from what I have last read. FDA recommends the test on the label so are we just going to throw valuable information and years of study and development out the window due to cost and roll the dice instead? BD
This study is being published in the Jan. 20, 2009, edition of Annals of Internal Medicine.
Warfarin is commonly prescribed to prevent blood clotting, particularly for patients with atrial fibrillation—a type of abnormal heart rhythm.
Mark Eckman, MD, professor of medicine at UC and lead investigator of the study, says the U.S. Food and Drug Administration changed the labeling for warfarin in 2007, suggesting that clinicians consider genetic testing before initiating therapy.
"There are certain genes that are known to contribute to an increased sensitivity to warfarin," he says. "The idea behind genetic testing—also known as pharmacogenetic-guided dosing— is to help guide the initial, and possibly lower, dose of warfarin for patients found to possess certain variants of the genes cytochrome P450 CYP2C9 and vitamin K epoxide reductase, or VKORC1. The hope is that more accurate dosing will translate into decreased major bleeds during the initiation phase of warfarin dosing, which is the first month or so."
Eckman says the study looked at whether the benefit of testing is worth the costs associated with it.