| DOI: 10.29090/psa.2026.04.26.11128 | Pharm Sci Asia 2026; 53(4), 509-524 |
Economic evaluations of genotype-guided warfarin dosing in cardiovascular patients: A systematic reviewPande Made Desy Ratnasari1,5, Tri Murti Andayani2*, Ika Puspita Sari2, Muhamad Taufik Ismail3, Dwi Endarti4
1 Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
2 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
3 Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital,
Yogyakarta, Indonesia
4 Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
5 Department of Pharmacy, Faculty of Pharmacy and Health Sciences, Universitas Pendidikan Nasional, Bali, Indonesia
Genotype-guided warfarin dosing has been shown to enhance clinical outcomes. However, this method has not been widely adopted in many countries. Furthermore, economic evaluations of this strategy show promising results, highlighting the need for a more comprehensive synthesis of the available evidence. This study aims to evaluate whether genotype-based warfarin dosing is more cost-effective than standard dosing in patients with cardiovascular disease. A literature search was conducted in Scopus and PubMed up to March 2026, following PRISMA guidelines. The studies included in this review focused on patients with cardiovascular disease receiving warfarin therapy, comparing genotype-guided warfarin dosing with standard therapy, and assessing outcomes in terms of ICER/QALY, thromboembolic and/or bleeding events. The reporting quality of the included studies was assessed using the CHEERS checklist. A total of ten out of 696 articles met the inclusion criteria (577 PubMed; 119 Scopus). The majority of the studies (60.00%) used cost-effectiveness analysis from the healthcare provider's perspective, with Markov models (70.00%). The cost of genetic testing varied across countries (USD 125-550). All studies reported increases in QALY and reductions in the risk of clinical events. However, only four studies concluded that this strategy was cost-effective. In contrast, six studies indicated that the high cost of genetic testing increased the overall cost of therapy. In conclusion, while genotype-guided warfarin dosing has been associated with improved clinical outcomes, its cost-effectiveness remains inconsistent across studies. Therefore, its implementation should be considered selectively, particularly in high-risk populations or in settings with lower costs for genetic testing.
Keyword:
Warfarin; Cardiovascular disease; Cost-effectiveness; Genetic polymorphism; Genotype-guided dosing
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