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Cost-effectiveness of genotype-guided acenocoumarol therapy in atrial fibrillation: a pharmacogenomic simulation

Maximiliano Mena1, Matías Carrasco1,2, Leslie C Cerpa1,3

  • 1Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Carlos Schachtebeck 299, Quinta Normal, Santiago, 8500000, Chile.

The Pharmacogenomics Journal
|April 20, 2026
PubMed

Insights

Genotype-guided acenocoumarol dosing in atrial fibrillation patients significantly improves outcomes and is cost-effective in Chile. Pharmacogenetic testing optimizes anticoagulation safety and efficacy.

Area of Science:

  • Pharmacogenomics
  • Cardiovascular Medicine
  • Health Economics

Background:

  • Cardiovascular diseases are a leading cause of death globally and in Chile.
  • Acenocoumarol is the standard anticoagulant in Chile for atrial fibrillation, but its dosing exhibits significant interindividual variability due to CYP2C9 and VKORC1 gene polymorphisms.
  • Optimizing anticoagulation is crucial for preventing adverse events.

Purpose of the Study:

  • To compare the cost-effectiveness of standard acenocoumarol dosing versus genotype-guided dosing in Chilean atrial fibrillation patients.
  • To evaluate the impact of population-level adherence on genotype-guided dosing strategies.
  • To inform policy decisions regarding pharmacogenetic implementation in Chile.

Main Methods:

  • Development of a cohort-based Markov model using data from 123 Chilean patients and 123 simulated individuals.
  • Comparison of three strategies: standard care, genotype-guided dosing, and adherence-adjusted genotype-guided dosing.
  • Cost-effectiveness analysis using quality-adjusted life years (QALYs) and direct medical costs, with a willingness-to-pay threshold of US$17,093.

Main Results:

  • Genotype-guided dosing yielded the highest effectiveness, with 2938.34 QALYs.
  • The incremental cost-effectiveness ratio for genotype-guided dosing versus standard care was US$436.86/QALY.
  • Genotype-guided dosing remained cost-effective even with significantly higher test prices in sensitivity analyses.

Conclusions:

  • Pharmacogenetic testing for acenocoumarol dosing is strongly supported for optimizing anticoagulation.
  • Implementing genotype-guided dosing can enhance safety, efficacy, and cost-effectiveness in Chilean patients.
  • This approach addresses a significant public health challenge in cardiovascular disease management.

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