The cost-effectiveness of HLA-B*5701 genetic screening to guide initial antiretroviral therapy for HIV.
The cost-effectiveness of HLA-B*5701 genetic screening to guide initial antiretroviral therapy for HIV.
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DOI：
10.1097/qad.0b013e3283103ce6
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发表时间：
2008-10-01
期刊：
影响因子：
--
通讯作者：
Sax PE
中科院分区：
文献类型：
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作者：
Schackman BR;Scott CA;Walensky RP;Losina E;Freedberg KA;Sax PE
评估HLA-B*5701检测的临床影响和成本效益，以指导美国一线HIV治疗方案的选择。使用艾滋病毒疾病模拟模型进行成本效益分析。HLA-B*5701的患病率以及服用阿巴卡韦的患者中确认和未确认的严重全身性超敏反应（HSR）的概率HLA-B*5701检测阳性和阴性来自PREDICT-1试验。阿巴卡韦和替诺福韦为基础的治疗方案的每月费用分别为1,135美元和1,139美元;假设病毒学疗效相似，敏感性分析中这一假设有所不同。开始HIV治疗的模拟患者队列。1)一线阿巴卡韦、拉米夫定和依法韦仑治疗前不进行HLA-B*5701检测; 2）相同的方案进行HLA-B*5701检测; 3）一线替诺福韦、恩曲他滨和依法韦仑。质量调整后的预期寿命和终身医疗成本以每年3%的折扣率贴现，成本效益比（$/QALY）。没有HLA-B*5701测试的阿巴卡韦治疗导致预期寿命30.93岁，折扣QALs 16.23，每人折扣终身成本472，200美元。HLA-B*5701检测增加了0.04个质量调整月，增量成本为110美元，与无检测相比，成本效益比为36，700美元/QALY。用替诺福韦为基础的方案开始治疗增加了成本，但没有改善QOLS。HLA-B*5701检测仍然是首选策略，只有当阿巴卡韦为基础的治疗具有相同的疗效和每月成本低于替诺福韦为基础的治疗。结果也对HLA-B*5701检测的成本和HLA-B * 5701的流行率敏感。只有当基于阿巴卡韦的治疗与基于替诺福韦的治疗一样有效且成本更低时，HLA-B*5701的药物遗传学测试才具有成本效益。
To evaluate the clinical impact and cost-effectiveness of HLA-B*5701 testing to guide selection of first-line HIV regimens in the United States. Cost-effectiveness analysis using a simulation model of HIV disease. The prevalence of HLA-B*5701 and the probabilities of confirmed and unconfirmed severe systemic hypersensitivity reaction (HSR) among patients taking abacavir testing HLA-B*5701 positive and negative were from the PREDICT-1 trial. The monthly costs of abacavir and tenofovir-based regimens were $1,135 and $1,139; similar virologic efficacy was assumed and this assumption was varied in sensitivity analysis. Simulated cohort of patients initiating HIV therapy. 1) first-line abacavir, lamivudine, and efavirenz without pre-treatment HLA-B*5701 testing; 2) the same regimen with HLA-B*5701 testing; 3) first-line tenofovir, emtricitabine, and efavirenz. Quality-adjusted life expectancy (QALYs) and lifetime medical costs discounted at 3% p.a., cost-effectiveness ratios ($/QALY). Abacavir-based treatment without HLA-B*5701 testing resulted in a projected 30.93 years life expectancy, 16.23 discounted QALYs, and $472,200 discounted lifetime cost per person. HLA-B*5701 testing added 0.04 quality-adjusted months at an incremental cost of $110, resulting in a cost-effectiveness ratio of $36,700/QALY compared to no testing. Initiating treatment with a tenofovir-based regimen increased costs without improving QALYs. HLA-B*5701 testing remained the preferred strategy only if abacavir-based treatment had equal efficacy and cost less per month than tenofovir-based treatment. Results were also sensitive to the cost of HLA-B*5701 testing and the prevalence of HLA*B5701. Pharmacogenetic testing for HLA-B*5701 is cost-effective only if abacavir-based treatment is as effective and costs less than tenofovir-based treatment.