Cost-effectiveness Analysis for Genotyping before Allopurinol Treatment to Prevent Severe Cutaneous Adverse Drug Reactions
| Autor: | Yu-Ching Lily Wang, Chien-Ning Hsu, Wen-Hung Chung, Cheng-Chih Wu, Yen-Hsia Wen, Ching-Hua Ke, Hung-Yi Chuang, Yaw-Bin Huang, You-Lin Tain |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Genotype Gout Allopurinol Cost-Benefit Analysis Immunology Gout Suppressants 03 medical and health sciences Benzbromarone chemistry.chemical_compound 0302 clinical medicine Rheumatology Internal medicine medicine Immunology and Allergy Humans 030212 general & internal medicine Genetic Testing Genotyping 030203 arthritis & rheumatology business.industry Cost-effectiveness analysis medicine.disease Surgery chemistry HLA-B Antigens Pharmacogenetics Cohort Febuxostat business medicine.drug Kidney disease |
| Zdroj: | The Journal of rheumatology. 44(6) |
| ISSN: | 0315-162X |
| Popis: | Objective.Patients with an HLA-B*58:01 allele have an increased risk of developing severe cutaneous adverse drug reactions (SCAR) when treated with allopurinol. Although one-off pharmacogenetic testing may prevent life-threatening adverse drug reactions, testing prior to allopurinol initiation incurs additional costs. The study objective was to evaluate the cost-effectiveness of HLA-B*58:01 screening compared with using other available urate-lowering agents (ULA).Methods.A decision-analytical model was used to compare direct medical costs and effectiveness [including lifetime saved, quality-adjusted life-yrs (QALY) gained] in treating new patients with the following options: (1) genetic screening followed by allopurinol prescribing for noncarriers of HLA-B*58:01, (2) prescribing benzbromarone without screening, (3) prescribing febuxostat without screening, and (4) prescribing allopurinol without screening. A 1-year time frame and third-party payer perspective were modeled for both the entire cohort (base-case) and for the subgroup of patients with chronic kidney disease (CKD).Results.The incremental cost-effectiveness ratio of genetic screening prior to ULA therapy was estimated as New Taiwan (NT) $234,610 (US$7508) per QALY gained in the base-case cohort. For patients with CKD, it was estimated as NT$230,925 (US$7390) per QALY. The study results were sensitive to the probability of benzbromarone/febuxostat-related hypersensitivity, and a negative predicted value of genotyping.Conclusion.HLA-B*58:01 screening gave good value for money in preventing allopurinol-induced SCAR in patients indicated for ULA therapy. In addition to the costs of genotyping, it is important to monitor ULA safety closely in adopting HLA-B*58:01 screening in practice. |
| Databáze: | OpenAIRE |
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