Genetic-guided pharmacotherapy for venous thromboembolism: a systematic and critical review of economic evaluations

Abstract

Despite the known contributions of genes, genetic-guided pharmacotherapy has not been routinely implemented for venous thromboembolism (VTE). To examine evidence on cost-effectiveness of genetic-guided pharmacotherapy for VTE, we searched six databases, websites of four HTA agencies and citations, with independent double-reviewers in screening, data extraction, and quality rating. The ten eligible studies, all model-based, examined heterogeneous interventions and comparators. Findings varied widely; testing was cost-saving in two base-cases, cost-effective in four, not cost-effective in three, dominated in one. Of 22 model variables that changed decisions about cost-effectiveness, effectiveness/relative effectiveness of the intervention was the most frequent, albeit of poor quality. Studies consistently lacked details on the provision of interventions and comparators as well as on model development and validation. Besides improving the reporting of interventions, comparators, and methodological details, future economic evaluations should examine strategies recommended in guidelines and testing key model variables for decision uncertainty, to advise clinical implementations.

Fig. 1. PRISMA flow chart.

The flow chart indicates the flow of study selection, from searching the bibliographic databases and the websites of health technology assessment (HTA) agencies, to study screening and the inclusion of 10 eligible articles.

Fig. 2. Characteristics of included studies.

The horizontal bar charts represent the number of studies with each characteristic (study context, simulated sample characteristic and study design).

Fig. 3. Overview of interventions and comparators.

The network diagram summarises the types of genetic-guided pharmacotherapy and the comparators for the 10 included studies.

Fig. 4. Findings of economic evaluations.

The 3 × 3 matrix presents each intervention in terms of whether its relative costs and relative effects are higher/better (+), no different (0) or lower/worse (−) from the comparator in the base-case.

Fig. 5. The vertical bar charts summarise the ratings for reporting and methodological quality respectively.

The y-axes of both charts represent the percentage of items whereas the numbers within the bars indicate the number of items with each rating. a Reporting and b methodological quality ratings.