title: Cost minimization of HLA-B*1502 screening before prescribing carbamazepine in Thailand.
abstract: BACKGROUND
  Carbamazepine (CBZ) is broadly used for the treatment of epilepsy, neuropathic pain and other neurological diseases, owing to its effectiveness and low price. CBZ can induce Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). There are several studies that found an association between HLA-B*1502 and CBZ-induced SJS/TEN, especially in people of Thai origin. In Thailand the prevalence of HLA-B*1502 was found to be in the range 8.1-14 %.
  
  
  OBJECTIVE
  This study aimed to determine if screening for HLA-B*1502 in Thai patients who were to receive CBZ is cost effective. Setting Srinagarind Hospital, Khon Kaen University, Thailand.
  
  
  METHODS
  A comparison between treatment cost of CBZ induced SJS/TEN and the HLAB*1502 screening costs in the Thai population.
  
  
  METHODS
  Comparison of the costs of treatment of CBZ induced SJS/TEN and costs of HLA-B*1502 screening test. Results When persons having the HLA-B*1502 allele receive CBZ, the chance of developing SJS/TEN is as high as 88.1 %, while persons without the HLA-B*1502 allele do not develop SJS/TEN. Therefore, a model was calculated to compare the cost of treatment between HLA-B*1502 testing before giving CBZ and if the patients were not tested for HLAB*1502. It was found that screening 100 patients before giving CBZ would save an amount of 98,549.94 baht per 100 cases of CBZ-prescribed patients.
  
  
  CONCLUSIONS
  The screening for HLA-B*1502 allele before giving carbamazepine is cost effective. The results of the present study may also apply to other populations if the HLA-B*1502 frequency is high enough.
authors: Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. somtia@kku.ac.th
authors: Somsak
authors: S
authors: Tiamkao
authors: Jukrapope
authors: J
authors: Jitpimolmard
authors: Kittisak
authors: K
authors: Sawanyawisuth
authors: Suthipun
authors: S
authors: Jitpimolmard
mesh_terms: D000483:Alleles; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004827:Epilepsy / Q000188:drug therapy; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics / Q000379:methods; D059910:HLA-B15 Antigen / Q000032:analysis* / Q000235:genetics; D006801:Humans; D015995:Prevalence; D013262:Stevens-Johnson Syndrome / Q000191:economics / Q000235:genetics / Q000517:prevention & control*; D013785:Thailand
chemical_list: D000927:Anticonvulsants; C483536:HLA-B*15:02 antigen; D059910:HLA-B15 Antigen; D002220:Carbamazepine
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