Ching-Hua Ke1,2, Wen-Hung Chung1,2, Yen-Hsia Wen1,2, Yaw-Bin Huang1,2, Hung-Yi Chuang1,2, You-Lin Tain1,2, Yu-Ching Lily Wang1,2, Cheng-Chih Wu1,2, Chien-Ning Hsu3,4. 1. From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 2. C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital. 3. From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. chien_ning_hsu@hotmail.com. 4. C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital. chien_ning_hsu@hotmail.com.
Abstract
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.
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.
Authors: Jason A Trubiano; Cosby A Stone; M Lindsay Grayson; Karen Urbancic; Monica A Slavin; Karin A Thursky; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2017-08-23
Authors: Rebecca Pavlos; Katie D White; Celestine Wanjalla; Simon A Mallal; Elizabeth J Phillips Journal: Immunol Allergy Clin North Am Date: 2017-11 Impact factor: 3.479