Ex ante economic evaluation of genetic testing for the ARG389 beta1-adrenergic receptor polymorphism to support bucindolol treatment decisions in Stage III/IV heart failure

Nimer S. Alkhatib, Kenneth Ramos, Marion Slack, Brian Erstad, Mahdi Gharaibeh, Walter Klimecki, Jason H. Karnes, Nancy K. Sweitzer, Ivo Abraham

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Background: Sub-analyses from the BEST trial in heart failure (HF) indicated that Arg389 homozygote patients may respond to bucindolol. Bucindolol is currently being evaluated in Arg389 genotype patients in the GENETIC-AF trial. Our aim is to conduct ex ante economic evaluations of Arg389 genetic testing to support β-blocker treatment in HF. Methods: Using survival results from two BEST sub-analyses, we constructed a decision-tree model (time-horizon 18 months, divided into three 6-month cycles) to estimate the cost-effectiveness/utility of Arg389 genetic testing with bucindolol or carvedilol versus no testing and empirical bucindolol. Costs of bucindolol and genetic testing were set conservatively at 1.5x carvedilol cost and $250, respectively. Incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were estimated. Results: Per one BEST sub-analysis, Arg389 genetic testing was associated with incremental gains of 0.29 life-years (LYs) and 0.27 quality-adjusted life years (QALYs) at incremental costs of $726; yielding ICER of US$2,503/LY and ICUR of US$2,688/QALY gained. Per a different BEST sub-analysis, Arg-389 genetic testing was associated with incremental gains of 0.35LYs and 0.32QALYs at savings of (US$1,081); for ICER of (US$3,089)/LY and ICUR of (US$3,378)/QALY gained. Conclusions: Assuming conservative cost estimates, Arg389 genetic testing to inform bucindolol versus carvedilol treatment decisions prevailed economically over bucindolol treatment without genetic testing.

Original languageEnglish (US)
Pages (from-to)319-329
Number of pages11
JournalExpert Review of Precision Medicine and Drug Development
Volume3
Issue number5
DOIs
StatePublished - Sep 3 2018

Keywords

  • Arg389
  • beta-blockers
  • cost-effectiveness
  • cost-utility
  • heart failure
  • precision medicine

ASJC Scopus subject areas

  • Molecular Medicine
  • Genetics
  • Pharmacology
  • Drug Discovery

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