title: Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
abstract: OBJECTIVE
  We evaluated the cost and efficiency of routine HLA-B*15 ∶ 02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.
  
  
  METHODS
  Data were extracted from patients who commenced CBZ as the first-ever AED treatment or tested for HLA-B*15 ∶ 02 allele in three years before policy implementation (pre-policy: 16 September 2005 to 15 September 2008) and three years after (post-policy: 16 September 2008 to 15 September 2011). Using published unit costs, we estimated the cost of screening by comparing the costs to prevent and treat CBZ-SJS/TEN. We compared the number of person-tests needed and the cost to prevent resultant death with cancer screening programs.
  
  
  RESULTS
  The number of screening tests needed to prevent one case of CBZ-SJS/TEN was 442, and to prevent one resultant death was 1,474 to 8,840. The screening cost was $332 per person, of which 42% was attributed to an additional consultation to review result and prescribe appropriate medication. HLA-B*15 ∶ 02 screening expended $146,749 to prevent a case of CBZ-SJS/TEN, and $489,386- $2,934,986 to prevent a resultant death. The corresponding numbers of tests and costs for mammography and Pap smear to prevent death due to breast and cervical cancers were 7,150 and 7,000, and $614,900 and $273,000, respectively. Comparing to the SJS/TEN treatment cost, HLA-B*15 ∶ 02 screening would become cost saving if a point-of-care test of less than $37 was available.
  
  
  CONCLUSIONS
  HLA-B*15 ∶ 02 screening is as efficient as mammography and Pap smear in preventing death. Development of point-of-care testing will vastly improve efficiency.
authors.affiliation: Department of Medicine, The University of Melbourne, Parkville, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Medicine, The University of Melbourne, Parkville, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia; Melbourne EpiCentre, Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
authors.forename: Patrick
authors.initials: P
authors.lastname: Kwan
mesh_terms: D000368:Aged; D044466:Asian People; D002220:Carbamazepine / Q000009:adverse effects* / Q000633:toxicity; D003365:Costs and Cost Analysis; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000191:economics / Q000235:genetics*; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D059910:HLA-B15 Antigen / Q000235:genetics; D006723:Hong Kong; D006801:Humans; D008297:Male; D008327:Mammography / Q000191:economics; D008875:Middle Aged; D065006:Papanicolaou Test; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy / Q000191:economics / Q000235:genetics* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000191:economics / Q000401:mortality
chemical_list: D059910:HLA-B15 Antigen; D002220:Carbamazepine