Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice

被引：16

作者：

Schackman, Bruce R. ^{[1
]}

Haas, David W. ^{[2
]}

Park, Sanghee S. ^{[3
]}

Li, X. Cynthia ^{[3
]}

Freedberg, Kenneth A. ^{[3
,4
,5
]}

机构：

[1] Weill Cornell Med Coll, Dept Healthcare Policy & Res, New York, NY 10065 USA

[2] Vanderbilt Univ, Sch Med, Dept Med, Div Infect Dis, Nashville, TN 37212 USA

[3] Massachusetts Gen Hosp, Med Practice Evaluat Ctr, Div Gen Internal Med, Boston, MA 02114 USA

[4] Massachusetts Gen Hosp, Div Infect Dis, Boston, MA 02114 USA

[5] Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA

来源：

PHARMACOGENOMICS | 2015年 / 16卷 / 18期

关键词：

antiretroviral therapy; cost-effectiveness; dose optimization; genotyping; HIV; INITIAL ANTIRETROVIRAL THERAPY; PLASMA-CONCENTRATIONS; DOSE REDUCTION; DOUBLE-BLIND; REGIMENS; PHARMACOKINETICS; POLYMORPHISMS; COMBINATION; METABOLISM; INFECTION;

D O I：

10.2217/pgs.15.142

中图分类号：

R9 [药学];

学科分类号：

1007 ;

摘要：

To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA. Methods: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses. Results: Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more. Conclusion: CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.

引用

页码：2007 / 2018

页数：12

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