Premium
Cost‐effectiveness of screening for HLA ‐ A *31:01 prior to initiation of carbamazepine in epilepsy
Author(s) -
Plumpton Catrin O.,
Yip Vincent L. M.,
Alfirevic Ana,
Marson Anthony G.,
Pirmohamed Munir,
Hughes Dyfrig A.
Publication year - 2015
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12937
Subject(s) - carbamazepine , medicine , epilepsy , adverse effect , lamotrigine , quality adjusted life year , pharmacogenetics , cost effectiveness , pediatrics , intensive care medicine , psychiatry , biology , biochemistry , risk analysis (engineering) , genotype , gene
Summary Objective Carbamazepine causes severe cutaneous adverse drug reactions that may be predicted by the presence of the HLA ‐ A *31:01 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 *31:01 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 ( QALY s) 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 *31:01 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.