Bruce R Schackman1, David W Haas2, Sanghee S Park3, X Cynthia Li3, Kenneth A Freedberg3,4,5. 1. Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA. 2. Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA. 3. Medical Practice Evaluation Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. 4. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Health Policy & Management, Harvard TH Chan School of Public Health, Boston, MA, USA.
Abstract
AIMS: To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses. RESULTS: Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more. CONCLUSION: CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.
AIMS: To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses. RESULTS: Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more. CONCLUSION:CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.
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