Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout



Plumpton, Catrin O, Alfirevic, Ana ORCID: 0000-0002-2801-9817, Pirmohamed, Munir ORCID: 0000-0002-7534-7266 and Hughes, Dyfrig A ORCID: 0000-0001-8247-7459
(2017) Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout. Rheumatology (Oxford, England), 56 (10). 1729 - 1739.

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Abstract

Objective. To determine whether prospective testing forHLA-B*58:01, as a strategy to prevent seriousadverse reactions to allopurinol in patients with gout, is cost-effective from the perspective of the NationalHealth Service in the UK. Methods. A systematic review and meta-analysis for the association ofHLA-B*58:01with cutaneous andhypersensitivity adverse drug reactions informed a decision analytic and Markov model to estimate lifetimecosts and outcomes associated with testingvsstandard care (with febuxostat prescribed for patients whotest positive). Scenario analyses assessed alternative treatment assumptions and patient populations. Results. The number of patients needed to test to prevent one case of adverse drug reaction was 11 286(95% central range (CR): 2573, 53 594). Cost and quality-adjusted life-year (QALY) gains were small, £103(95% CR: £98, £106) and 0.0023 (95% CR: 0.0006, 0.0055), respectively, resulting in an incrementalcost-effectiveness ratio (ICER) of £44 954 per QALY gained. The probability of testing being cost-effectiveat a threshold of £30 000 per QALY was 0.25. Reduced costs of testing or febuxostat resulted in an ICERbelow £30 000 per QALY gained. The ICER for patients with chronic renal insufficiency was £38 478 perQALY gained. Conclusion. Routine testing forHLA-B*58:01in order to reduce the incidence of adverse drug reactions inpatients being prescribed allopurinol for gout is unlikely to be cost-effective in the UK; however testing isexpected to become cost-effective with reductions in the cost of genotyping, and with the future avail-ability of cheaper, generic febuxostat

Item Type: Article
Uncontrolled Keywords: allopurinol, pharmacogenetics, cutaneous adverse drug reaction, cost-effectiveness analysis, HLA-B*58:01
Depositing User: Symplectic Admin
Date Deposited: 09 Oct 2017 15:13
Last Modified: 20 Dec 2021 21:11
DOI: 10.1093/rheumatology/kex253
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3009826