AdDIT Editorial comment—challenges in medication treatment of renal and cardiovascular diseases and risk factors in adolescents with type 1 diabetes

A large body of evidence revealed that compared with children and adolescents in the general population, those with type 1 diabetes mellitus (T1DM) are at excessive risk of diabetes related complications (1,2). Presence and long-term diabetes complications are known to increase cardiovascular (CV) morbidity and mortality in population with T1DM in which 26.1% of all deaths are associated with diabetes complications (3)

Terrace Review, May, 28, 1986

Thrombosis and Hemostasi

Future of Pharmacogenetics in Cardiovascular Diseases

Introduction: Pharmacogenetics is the study of variations in DNA sequence as related to drug response (European Medicines Agency [EMA], 2007). Several gene-drug interactions have been discovered in the field of cardiovascular diseases (CVDs). These gene-drug interactions can help to identify nonresponse to drugs, estimate dose requirements or identify an increased risk of developing adverse drug reactions. An individualized approach based on pharmacogenetic testing will provide physicians and pharmacists with tools for decision making about pharmacotherapy. While pharmacogenetic testing is already part of everyday practice in oncology, it is not widely implemented in the field of CVDs. However, in the near future, pharmacogenetics will probably also play a valuable role in this field as well

Economic evaluation of a pharmacogenetic dosing algorithm for coumarin anticoagulants in The Netherlands

Aims: to investigate the cost-effectiveness of a pharmacogenetic dosing algorithm versus a clinical dosing algorithm for coumarin anticoagulants in The Netherlands. Materials & methods: A decision-analytic Markov model was used to analyze the cost-effectiveness of pharmacogenetic dosing of phenprocoumon and acenocoumarol versus clinical dosing. Results: Pharmacogenetic dosing increased costs by €33 and QALYs by 0.001. The incremental cost-effectiveness ratios (ICERs) were €28,349 and €24,427 per QALY gained for phenprocoumon and acenocoumarol respectively. At a willingness to pay threshold of €20,000 per QALY, the pharmacogenetic dosing algorithm was not likely to be cost-effective compared to the clinical dosing algorithm. Conclusions: Pharmacogenetic dosing improves health only slightly when compared with clinical dosing. However, availability of low-cost genotyping would make it a cost-effective option

Cost-effectiveness of new oral anticoagulants for stroke prevention in patients with atrial fibrillation in two different European healthcare settings

Objectives: To investigate the cost-effectiveness of apixaban, rivaroxaban and dabigatran, compared to coumarin derivatives for stroke prevention in patients with atrial fibrillation in a country with specialized anticoagulation clinics (The Netherlands) and in a country without these clinics (the United Kingdom). Methods: A decision-analytic Markov model was used to analyse the cost-effectiveness of apixaban, rivaroxaban and dabigatran compared to coumarin derivatives in The Netherlands and the United Kingdom over a lifetime horizon. Results: In the Netherlands, the use of rivaroxaban, apixaban or dabigatran increased health by 0.166, 0.365 and 0.374 quality-adjusted life-years (QALYs) compared to coumarin derivatives, but also increased costs by €5,681, €4,754 and €5,465, respectively. The incremental cost-effectiveness ratios (ICERs) were €34,248, €13,024 and €14,626 per QALY gained. In the United Kingdom, health was increased by 0.302, 0.455 and 0.461 QALYs and the incremental costs were similar for all three new oral anticoagulants (€5,118 to €5,217). The ICERs varied from €11,172 to €16,949 per QALY gained. In The Netherlands, apixaban had the highest chance (37%) to be cost-effective at a threshold of €20,000 and in the United Kingdom this chance was 41% for dabigatran. The quality of care reflected in time in therapeutic range had an important influence on the ICER. Conclusions: Apixaban, rivaroxaban and dabigatran are cost-effective alternatives to coumarin derivatives in the United Kingdom, while in The Netherlands, only apixaban and dabigatran could be considered cost-effective. The cost-effectiveness of the new oral anticoagulants is largely dependent on the setting and quality of local anticoagulant care facilities

Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands

Rationale and objectives Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands. Methods We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population. Findings During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patient

Clinical and economic consequences of pharmacogenetic-guided dosing of warfarin

Patients using warfarin for oral anticoagulant therapy need to be frequently monitored because of warfarins narrow therapeutic range and the large variation in dose requirements among patients. Patients receiving the wrong dose have an increased risk of bleeding or thromboembolic events. The required dose is influenced by environmental factors, such as gender, age, diet and concomitant medication, as well as genetic factors. Pharmacogenetic testing prior to warfarin initiation might improve dosing accuracy and, therefore, safety and efficacy of warfarin treatment. Meckley et al. studied the clinical consequences and costs of genotyping before warfarin treatment. The results of their study suggest that pharmacogenetic-guided dosing of patients initiating warfarin could improve health (quality-adjusted life-years) but at a high cost per quality-adjusted life-year gained. Owing to the inevitable assumptions that have to be made in all cost-effectiveness models, great uncertainty remains regarding the cost-effectiveness of pharmacogenetic-guided warfarin dosing