Cost-effectiveness analysis of HLA B*5701 genotyping in preventing abacavir hypersensitivity
Cost-effectiveness analysis of HLA B*5701 genotyping in preventing abacavir hypersensitivity
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DOI：
10.1097/00008571-200406000-00002
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发表时间：
2004-06-01
期刊：
影响因子：
--
通讯作者：
Pirmohamed, M
中科院分区：
文献类型：
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作者：
Hughes, DA;Vilar, FJ;Pirmohamed, M
目的阿巴卡韦（Abacavir）是一种人类免疫缺陷病毒1型（HIV-1）核苷类似物逆转录酶抑制剂，可引起4-8%的患者严重过敏。HLA B*5701是白种人中阿巴卡韦超敏反应的已知遗传风险因素。我们的目的是确认这种遗传因素在我们的患者的存在下，并确定是否HLA B*5701基因分型将是一个具有成本效益的使用healthcare resources.Methods阿巴卡韦超敏反应患者从英国HIV诊所确定。对患者进行HLA B*5701基因分型，并将合并数据用于计算测试特征。成本效益分析包括检测成本、阿巴卡韦过敏治疗成本以及替代抗逆转录病毒治疗方案的成本和选择。一个概率决策分析模型（比较测试与没有测试）制定和Monte Carlo simulationsperformed.Results阿巴卡韦过敏患者，6（46%）是HLA B*5701阳性，相比之下，5（10%）的非过敏患者（优势比7.9 [95%置信区间1.5-41.4]，P = 0.006）。将我们关于HLA B*5701的数据与已发表的数据合并，得出合并优势比为29（95%CI 6.4-132.3; P < 0.0001）。成本-效果模型表明，根据比较者的选择，HLA B*5701的常规检测范围从占主导地位的策略（比不测试更便宜，更有益），以增加成本效益比结论阿巴卡韦超敏反应与HLA B*5701相关，并且用于此的处方前药物遗传学测试似乎是对医疗保健资源的具有成本效益的使用。药物遗传学14：335-342（C）2004 Lippincott威廉姆斯威尔金斯。
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 22811 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. Pharmacogenetics 14:335-342 (C) 2004 Lippincott Williams Wilkins.