title: Cost-effectiveness analysis of HLA-B5801 genotyping in the treatment of gout patients with chronic renal insufficiency in Korea.
abstract: OBJECTIVE
  Allopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare but cause high rates of morbidity and mortality. Studies have shown that the HLA-B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guidelines recommend that, prior to treatment with allopurinol, the HLA-B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown. This study evaluated the cost-effectiveness of HLA-B5801 genotyping for the treatment of gout in patients with chronic renal insufficiency in Korea.
  
  
  METHODS
  A decision analytical model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA-B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real patients with SCARs from 2 tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio.
  
  
  RESULTS
  In the base model, the total expected cost and probability of continuation of gout treatment without SCARs for the conventional and HLA-B5801 screening strategies were $1,193 and 97.8% and $1,055 and 100%, respectively. The results were robust according to sensitivity analyses.
  
  
  CONCLUSIONS
  Our model suggests that gout treatment informed by HLA-B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA-B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths.
authors.affiliation: Chonnam National University Medical School & Hospital, Gwangju, Korea.
authors.forename: Dong-Jin
authors.initials: DJ
authors.lastname: Park
authors.forename: Ji-Hyoun
authors.initials: JH
authors.lastname: Kang
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Kyung-Eun
authors.initials: KE
authors.lastname: Lee
authors.forename: Lihui
authors.initials: L
authors.lastname: Wen
authors.forename: Tae-Jong
authors.initials: TJ
authors.lastname: Kim
authors.forename: Yong-Wook
authors.initials: YW
authors.lastname: Park
authors.forename: Sung-Hwan
authors.initials: SH
authors.lastname: Park
authors.forename: Shin-Seok
authors.initials: SS
authors.lastname: Lee
mesh_terms: D000493:Allopurinol / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003875:Drug Eruptions / Q000191:economics / Q000235:genetics*; D005838:Genotype; D060005:Genotyping Techniques / Q000191:economics; D006073:Gout / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D006074:Gout Suppressants / Q000009:adverse effects / Q000191:economics; D015235:HLA-B Antigens / Q000235:genetics*; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000235:genetics; D056910:Republic of Korea
chemical_list: D006074:Gout Suppressants; D015235:HLA-B Antigens; D000493:Allopurinol