Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease?

被引：7
作者：
Teng, Gim Gee [1 ,2 ]
Tan-Koi, Wei-Chuen [3 ]
Dong, Di [4 ]
Sung, Cynthia [3 ,5 ]
机构：
[1] Natl Univ Hlth Syst, Univ Med Cluster, Div Rheumatol, Singapore 119228, Singapore
[2] Natl Univ Hlth Syst, Alexandra Hosp, Chron Program, Singapore 159964, Singapore
[3] Hlth Sci Author, Vigilance & Compliance Branch, Singapore 138667, Singapore
[4] Duke Kunshan Univ, Global Hlth Res Ctr, Suzhou 215316, Peoples R China
[5] Duke NUS Med Sch, Hlth Serv & Syst Res, Singapore 169857, Singapore
来源：
PHARMACOGENOMICS | 2020年 / 21卷 / 04期
关键词：
chronic kidney disease; cost-effectiveness; gout; HLA-B*5801 genotyping; Stevens-Johnson syndrome; toxic epidermal necrolysis; STEVENS-JOHNSON-SYNDROME; TOXIC EPIDERMAL NECROLYSIS; URATE-LOWERING THERAPY; SERUM URATE; STARTING ALLOPURINOL; RENAL-INSUFFICIENCY; NEW-ZEALAND; RISK; COMPLICATIONS; MANAGEMENT;
D O I：
10.2217/pgs-2019-0160
中图分类号：
R9 [药学];
学科分类号：
1007 ;
摘要：
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.
引用
收藏
页码：279 / 291
页数：13
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