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Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease?
Pharmacogenomics. 2020 03; 21(4):279-291.P

Abstract

Aim: Concerns for fatal severe cutaneous adverse reactions (SCARs) hamper allopurinol use. Methods and material: We adopted a health system perspective to evaluate the cost-effectiveness of HLA-B*58:01 genotyping before allopurinol initiation. A decision tree compared three treatment strategies in gout patients with chronic kidney disease who have higher risk for SCAR. They were standard allopurinol treatment followed by febuxostat in nonresponders, test-positive patients receive febuxostat while test-negative receive allopurinol and universal use of febuxostat. Results: The first strategy was the most cost effective. Genotyping dominated universal febuxostat use. Time horizon and SCAR incidence were the most influential factors on the incremental cost-effectiveness ratio. Conclusion: HLA-B*58:01 genotyping compared with standard allopurinol-febuxostat sequential treatment does not provide good value for money in gout with chronic kidney disease.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Teng GG
Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, 119228. Chronic Program, Alexandra Hospital, National University Health System, Singapore, 159964.
Tan-Koi WC
Vigilance & Compliance Branch, Health Sciences Authority, Singapore, 138667.
Dong D
Global Health Research Center, Duke Kunshan University, China, 215316.
Sung C
Vigilance & Compliance Branch, Health Sciences Authority, Singapore, 138667. Health Services & Systems Research, Duke-NUS Medical School, Singapore, 169857.

MeSH

AgedAged, 80 and overAllopurinolCost-Benefit AnalysisFemaleGenetic TestingGenotypeGoutGout SuppressantsHLA-B AntigensHumansMaleMiddle AgedRenal Insufficiency, Chronic

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32180492

Citation

Teng, Gim Gee, et al. "Is HLA-B*58:01 Genotyping Cost Effective in Guiding Allopurinol Use in Gout Patients With Chronic Kidney Disease?" Pharmacogenomics, vol. 21, no. 4, 2020, pp. 279-291.
Teng GG, Tan-Koi WC, Dong D, et al. Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease? Pharmacogenomics. 2020;21(4):279-291.
Teng, G. G., Tan-Koi, W. C., Dong, D., & Sung, C. (2020). Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease? Pharmacogenomics, 21(4), 279-291. https://doi.org/10.2217/pgs-2019-0160
Teng GG, et al. Is HLA-B*58:01 Genotyping Cost Effective in Guiding Allopurinol Use in Gout Patients With Chronic Kidney Disease. Pharmacogenomics. 2020;21(4):279-291. PubMed PMID: 32180492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease? AU - Teng,Gim Gee, AU - Tan-Koi,Wei-Chuen, AU - Dong,Di, AU - Sung,Cynthia, Y1 - 2020/03/17/ PY - 2020/3/18/pubmed PY - 2021/1/28/medline PY - 2020/3/18/entrez KW - HLA-B*5801 genotyping KW - Stevens–Johnson syndrome KW - chronic kidney disease KW - cost–effectiveness KW - gout KW - toxic epidermal necrolysis SP - 279 EP - 291 JF - Pharmacogenomics JO - Pharmacogenomics VL - 21 IS - 4 N2 - Aim: Concerns for fatal severe cutaneous adverse reactions (SCARs) hamper allopurinol use. Methods and material: We adopted a health system perspective to evaluate the cost-effectiveness of HLA-B*58:01 genotyping before allopurinol initiation. A decision tree compared three treatment strategies in gout patients with chronic kidney disease who have higher risk for SCAR. They were standard allopurinol treatment followed by febuxostat in nonresponders, test-positive patients receive febuxostat while test-negative receive allopurinol and universal use of febuxostat. Results: The first strategy was the most cost effective. Genotyping dominated universal febuxostat use. Time horizon and SCAR incidence were the most influential factors on the incremental cost-effectiveness ratio. Conclusion: HLA-B*58:01 genotyping compared with standard allopurinol-febuxostat sequential treatment does not provide good value for money in gout with chronic kidney disease. SN - 1744-8042 UR - https://www.unboundmedicine.com/medline/citation/32180492/Is_HLA_B_58:01_genotyping_cost_effective_in_guiding_allopurinol_use_in_gout_patients_with_chronic_kidney_disease DB - PRIME DP - Unbound Medicine ER -