Open AccessCost-effectiveness analysis of genotyping for HLA-B*15:02 in Indonesian patients with epilepsy using a generic model
Author(s) -
Rika Yuliwulandari,
Jae Gook Shin,
Erna Kristin,
Fransiscus D. Suyatna,
Iwan Dwi Prahasto,
Kinasih Prayuni,
Surakameth Mahasirimongkol,
Larisa H. Cavallari,
Christina Mitropoulou,
George P. Patrinos,
Jing Hao,
Marc S. Williams,
Susan Snyder
Publication year - 2021
Publication title -
pharmacogenomics journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.804
H-Index - 85
eISSN - 1473-1150
pISSN - 1470-269X
DOI - 10.1038/s41397-021-00225-9
Subject(s) - indonesian , carbamazepine , genotyping , medicine , medical prescription , cost effectiveness , epilepsy , hla b , quality adjusted life year , human leukocyte antigen , pharmacology , immunology , psychiatry , biology , risk analysis (engineering) , antigen , philosophy , linguistics , biochemistry , genotype , gene
Carbamazepine (CBZ)-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are strongly associated with the HLA-B*15:02 allele. Screening HLA-B*15:02 before CBZ administration might prevent CBZ-induced SJS/TEN by enabling clinicians to prescribe alternative therapy for positive patients. Similar to other Southeastern Asian countries, HLA-B*15:02 is highly prevalent in Indonesia. Therefore, we assessed the economic value of HLA-B*15:02 screening before CBZ prescription to patients with epilepsy in Indonesia. A generic cost-effectiveness model and decision support tool, developed to enable users to perform an initial cost-effectiveness analysis from a healthcare provider/payer perspective, were used to assess the value of HLA-B*15:02 genotyping. The incremental cost-effectiveness ratio of adopting universal HLA-B*15:02 screening was 656,444,671 Indonesian Rupiah (IDR)/quality-adjusted life year (QALY) gained for patients compared with 2,634,975,574 IDR/QALY gained for providing valproic acid (alternative drug) without screening. Thus, neither HLA-B*15:02 screening nor substitution with VPA meets the Indonesian threshold for cost effectiveness. However, the improved outcomes with this test in other Asian countries may inform the desirability of implementation in Indonesia even with suboptimal cost-effectiveness.