Pharmacogenetic HLA-B*58:01 Testing to Prevent Allopurinol-Induced SJS/TEN in Vietnamese Population: A Cost-Effectiveness Analysis
Author(s)
Duong K1, Nguyen DV2, Chaiyakunapruk N1, Nelson RE3, Malone DC1
1Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA, 2Department of Internal Medicine, Respiratory, Allergy & Clinical Immunology Unit, Vinmec Healthcare system, Hanoi, Viet Nam, 3Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT, USA
Presentation Documents
OBJECTIVES:
HLA-B*58:01 is strongly associated with allopurinol-induced SJS/TEN in Vietnamese population. However, there is a paucity of the cost-effectiveness of genetic testing for at risk populations. The purpose of this study was to assess the cost-effectiveness of HLA-B*58:01 testing to prevent allopurinol-induced SJS/TEN in Vietnamese population.METHODS:
A Markov decision model from a healthcare payer perspective was developed to compare three strategies (1) No HLA-B*58:01 screening, patients initiate allopurinol (current practice); (2) HLA-B*58:01 screening, patients initiate allopurinol if HLA-B*58:01 positive otherwise probenecid is provided; and (3) no HLA-B*58:01 screening, patients initiate probenecid. A lifetime horizon and 1-year cycle length were applied. One-way sensitivity analysis and probability sensitivity analyses were performed to investigate the robustness of the results. A 3-time GDP per capita was used as the willingness-to-pay (WTP) threshold.RESULTS:
Compared to the current practice, HLA-B*58:01 screening was expected to increase QALYs by 0.0069 and increase costs by VND 14,283,633 ($US 617), with an ICER of VND 2,070,459,122 ($US 89,398) per QALY. HLA-B*58:01 screening was not cost-effective at a predefined threshold. The probability of testing being cost-effective at the WTP threshold was 0.11. The ICER of the third strategy, only using probenecid, was much higher than the ICER of HLA-B*58:01 screening (VND 15,087,885,880 ($US 651,463) per QALY gained). Sensitivity analyses found that the prevalence of allopurinol-induced SJS/TEN was the most influential factor.CONCLUSIONS:
HLAB*58:01 genetic testing screening prior to allopurinol is currently unlikely to be cost-effective in Vietnam with a 3-fold GDP WTP threshold from healthcare payer perspective.Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
EE94
Topic
Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Diagnostics & Imaging
Disease
Personalized & Precision Medicine