title: Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice.
abstract: OBJECTIVE
  To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA.
  
  
  METHODS
  We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses.
  
  
  RESULTS
  Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more.
  
  
  CONCLUSIONS
  CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.
authors.affiliation: Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Haas
authors.affiliation: Medical Practice Evaluation Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Sanghee S
authors.initials: SS
authors.lastname: Park
authors.affiliation: Medical Practice Evaluation Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: X Cynthia
authors.initials: XC
authors.lastname: Li
authors.affiliation: Medical Practice Evaluation Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.|Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.|Department of Health Policy & Management, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000191:economics*; D048588:Benzoxazines / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D065702:Cytochrome P-450 CYP2B6 / Q000235:genetics*; D005838:Genotype; D060005:Genotyping Techniques / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000201:enzymology; D006801:Humans; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D065702:Cytochrome P-450 CYP2B6; C098320:efavirenz
keywords: HIV; antiretroviral therapy; cost–effectiveness; dose optimization; genotyping