title: Cost-effectiveness of screening for HLA-A*31:01 prior to initiation of carbamazepine in epilepsy.
abstract: OBJECTIVE
  Carbamazepine causes severe cutaneous adverse drug reactions that may be predicted by the presence of the HLA-A*31:01 allele in northern European populations. There is uncertainty as to whether routine testing of patients with epilepsy is cost-effective. We conducted an economic evaluation of HLA-A*31:01 testing from the perspective of the National Health Service (NHS) in the United Kingdom.
  
  
  METHODS
  A short-term, decision analytic model was developed to estimate the outcomes and costs associated with a policy of routine testing (with lamotrigine prescribed for patients who test positive) versus the current standard of care, which is carbamazepine prescribed without testing. A Markov model was used to estimate total costs and quality-adjusted life-years (QALYs) over a lifetime to account for differences in drug effectiveness and the long-term consequences of adverse drug reactions.
  
  
  RESULTS
  Testing reduced the expected rate of cutaneous adverse drug reactions from 780 to 700 per 10,000 patients. The incremental cost-effectiveness ratio for pharmacogenetic testing versus standard care was £12,808 per QALY gained. The probability of testing being cost-effective at a threshold of £20,000 per QALY was 0.80, but the results were sensitive to estimated remission rates for alternative antiepileptic drugs (AEDs).
  
  
  CONCLUSIONS
  Routine testing for HLA-A*31:01 in order to reduce the incidence of cutaneous adverse drug reactions in patients being prescribed carbamazepine for epilepsy is likely to represent a cost-effective use of health care resources.
authors.forename: Catrin O
authors.initials: CO
authors.lastname: Plumpton
authors.forename: Vincent L M
authors.initials: VL
authors.lastname: Yip
authors.forename: Ana
authors.initials: A
authors.lastname: Alfirevic
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Marson
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
authors.forename: Dyfrig A
authors.initials: DA
authors.lastname: Hughes
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000191:economics; D002220:Carbamazepine / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D003663:Decision Trees; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000517:prevention & control; D004827:Epilepsy / Q000188:drug therapy / Q000191:economics* / Q000235:genetics; D005820:Genetic Testing / Q000191:economics* / Q000379:methods; D015234:HLA-A Antigens / Q000191:economics* / Q000235:genetics; D006801:Humans; D008297:Male
chemical_list: D000927:Anticonvulsants; D015234:HLA-A Antigens; C506273:HLA-A*31:01 antigen; D002220:Carbamazepine