Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany.
OBJECTIVE
Avoiding abacavir in HIV-infected patients tested positive for HLA-B*5701 reduces the risk of abacavir hypersensitivity reaction (ABC-HSR). Our aim was to assess the costs of clinically suspected HSR and to estimate potential cost savings of implementing prospective HLA-B*5701-screening for HIV-infected patients initiating abacavir/lamivudine fixed-dose combination (ABC/3TC FDC) compared to initiating respective treatment without screening.


METHODS
Employing a decision tree model the expected HSR-related costs of screening vs. no screening were estimated from the societal and healthcare payer perspective (reference year 2007). A retrospective standardized assessment of all clinically suspected ABC-HSR cases without screening at 5 German HIV-centres was performed to measure resource consumption. In- and outpatient care, discarded ABC/3TC FDC and concomitant medication were considered. Direct resource utilization was valued using German fees (EBM, G-DRGs). Indirect costs were measured with the human capital approach. Estimates for the HLA-B*5701-prevalence, HSR-incidence, and hospitalization rate were based on clinical trials and cohorts and it was assumed that screening reduces the incidence of clinically suspected ABC-HSR from 10% to 0.5%.


RESULTS
Thirty-two ABC-HSR cases were identified from 1998 to 2007. Mean direct and total costs per clinically suspected HSR case were Euro 1,362 and Euro 2,235, respectively. Hospital costs contributed 63.3% to direct costs. Potential cost savings when implementing genetic screening were estimated at Euro 44 and Euro 127 per screened patient, from a healthcare payer or societal perspective.


CONCLUSIONS
HLA-B*5701 screening prior to ABC/3TC FDC initiation prevents significant HSR-related costs per screened patient and is likely to lead to overall net savings.
Wolf
Eva
E
MUC Research GmbH, Karlsplatz 8, 80335 Munich, Germany. ewo@mucresearch.de
Blankenburg
M
M
Bogner
J R
JR
Becker
W
W
Gorriahn
D
D
Mueller
M C
MC
Jaeger
H
H
Welte
R
R
Baudewig
M
M
Walli
R
R
Stoll
M
M
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D015224:Dideoxynucleosides / Q000009:adverse effects* / Q000627:therapeutic use*; D004342:Drug Hypersensitivity / Q000191:economics / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005858:Germany; D015235:HLA-B Antigens / Q000032:analysis*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008403:Mass Screening / Q000191:economics*; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D000099227:Abacavir
D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D015235:HLA-B Antigens; D019259:Lamivudine; D018894:Reverse Transcriptase Inhibitors; D000099227:Abacavir; C484830:HLA-B*57:01 antigen