Cost-effectiveness analysis of HLA-B*13:01 screening for the prevention of co-trimoxazole-induced severe cutaneous adverse reactions among HIV-infected patients in Thailand
Warittakorn Kategeaw, Nontaya Nakkam, Sasisopin Kiertiburanakul, Chonlaphat Sukasem, Wicittra Tassaneeyakul, ณธร ชัยญาคุณาพฤกษ์*
Department of Pharmacotherapy, College of Pharmacy The University of Utah, 30 2000 E, Salt Lake City, UT 84112, USA; Email: Nathorn.chaiyakunapruk@utah.edu
บทคัดย่อ
Studies found a strong association between HLA-B*13:01 allele and co-trimoxazole-induced severe cutaneous adverse reactions (SCARs). Genetic screening before initiation of co-trimoxazole may decrease the incidence of co-trimoxazole-induced SCARs. This study aims to evaluate the cost-effectiveness of HLA-B*13:01 screening before co-trimoxazole initiation in HIV-infected patients in Thailand. A combination of a decision tree model and a Markov model was used to estimate lifetime costs and outcomes of two strategies including 1) HLA-B*13:01 screening before co-trimoxazole initiation and 2) usual practice from a societal perspective. Alternative drugs are not considered because dapsone (the second-line drug) also presents a genetic risk. Input parameters were obtained from literature, government documents, and part of the TREAT Asia HIV Observational Database (TAHOD). One-way sensitivity analyses and probabilistic analyses were performed to determine robustness of the findings. HLA-B*13:01 screening resulted in 0.0061 quality-adjusted life years (QALYs) loss with an additional cost of 370 THB ($11.84). At the cost-effectiveness threshold of 160,000 THB ($5,112.85), the probability of the genetic screening strategy being cost-effective is 9.54%. This analysis demonstrated that HLA-B*13:01 allele screening before initiation of co-trimoxazole among HIV-infected patients is unlikely to be cost-effective in Thailand. Our findings will help policymakers make an evidence-informed decision making.
 
 
ที่มา
Journal of Medical Economics ปี 2566, ปีที่: 26 ฉบับที่ 1 หน้า 1330-1341
คำสำคัญ
HIV, Safety, HLA-B*13:01 genotyping, severe cutaneous adverse HLA-B*13:01 genotyping, severe cutaneous adverse reactions, SCARs, cotrimoxazole, costeffectiveness