Cost-effectiveness of screening for HLA-A*31:01 prior to initiation of carbamazepine in epilepsy.
Epilepsia
; 56(4): 556-63, 2015 Apr.
Article
em En
| MEDLINE
| ID: mdl-26046144
ABSTRACT
OBJECTIVE:
Carbamazepine causes severe cutaneous adverse drug reactions that may be predicted by the presence of the HLA-A*3101 allele in northern European populations. There is uncertainty as to whether routine testing of patients with epilepsy is cost-effective. We conducted an economic evaluation of HLA-A*3101 testing from the perspective of the National Health Service (NHS) in the United Kingdom.METHODS:
A short-term, decision analytic model was developed to estimate the outcomes and costs associated with a policy of routine testing (with lamotrigine prescribed for patients who test positive) versus the current standard of care, which is carbamazepine prescribed without testing. A Markov model was used to estimate total costs and quality-adjusted life-years (QALYs) over a lifetime to account for differences in drug effectiveness and the long-term consequences of adverse drug reactions.RESULTS:
Testing reduced the expected rate of cutaneous adverse drug reactions from 780 to 700 per 10,000 patients. The incremental cost-effectiveness ratio for pharmacogenetic testing versus standard care was £12,808 per QALY gained. The probability of testing being cost-effective at a threshold of £20,000 per QALY was 0.80, but the results were sensitive to estimated remission rates for alternative antiepileptic drugs (AEDs).SIGNIFICANCE:
Routine testing for HLA-A*3101 in order to reduce the incidence of cutaneous adverse drug reactions in patients being prescribed carbamazepine for epilepsy is likely to represent a cost-effective use of health care resources.
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Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
Base de dados:
MEDLINE
Assunto principal:
Carbamazepina
/
Antígenos HLA-A
/
Testes Genéticos
/
Análise Custo-Benefício
/
Epilepsia
Tipo de estudo:
Diagnostic_studies
/
Health_economic_evaluation
/
Prognostic_studies
/
Screening_studies
Aspecto:
Patient_preference
Limite:
Adult
/
Humans
/
Male
Idioma:
En
Revista:
Epilepsia
Ano de publicação:
2015
Tipo de documento:
Article