| Title | Cost-effectiveness analysis of HLA B*5701 genotyping in preventing abacavir hypersensitivity. | | Author(s) | Hughes DA, Vilar FJ, Ward CC, Alfirevic A, Park BK, Pirmohamed M | | Institution | Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, L69 3GE, UK. | | Source | Pharmacogenetics 2004 Jun; 14(6):335-42. | | MeSH | Adult
Cost-Benefit Analysis
Dideoxynucleosides
Drug Hypersensitivity
Female
Genotype
HIV Infections
HIV-1
HLA-B Antigens
Humans
Male
Middle Aged
Molecular Diagnostic Techniques
Monte Carlo Method
Odds Ratio
Pharmacogenetics
Point-of-Care Systems
Reverse Transcriptase Inhibitors
Risk Factors
| | Abstract | OBJECTIVE: Abacavir, a human immunodeficiency virus-1 (HIV-1) nucleoside-analogue reverse transcriptase inhibitor, causes severe hypersensitivity in 4-8% of patients. HLA B*5701 is a known genetic risk factor for abacavir hypersensitivity in Caucasians. Our aim was to confirm the presence of this genetic factor in our patients, and to determine whether genotyping for HLA B*5701 would be a cost-effective use of healthcare resources.
METHODS: Patients with and without abacavir hypersensitivity were identified from a UK HIV clinic. Patients were genotyped for HLA B*5701, and pooled data used for calculation of test characteristics. The cost-effectiveness analysis incorporated the cost of testing, cost of treating abacavir hypersensitivity, and the cost and selection of alternative antiretroviral regimens. A probabilistic decision analytic model (comparing testing versus no testing) was formulated and Monte Carlo simulations performed.
RESULTS: Of the abacavir hypersensitive patients, six (46%) were HLA B*5701 positive, compared to five (10%) of the non-hypersensitive patients (odds ratio 7.9 [95% confidence intervals 1.5-41.4], P = 0.006). Pooling of our data on HLA B*5701 with published data resulted in a pooled odds ratio of 29 (95% CI 6.4-132.3; P < 0.0001). The cost-effectiveness model demonstrated that depending on the choice of comparator, routine testing for HLA B*5701 ranged from being a dominant strategy (less expensive and more beneficial than not testing) to an incremental cost-effectiveness ratio (versus no testing) of Euro 22,811 per hypersensitivity reaction avoided.
CONCLUSIONS: Abacavir hypersensitivity is associated with HLA B*5701, and pre-prescription pharmacogenetic testing for this appears to be a cost-effective use of healthcare resources. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15247625 |
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