title: Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia.
abstract: BACKGROUND
  A strong association has been documented between HLA-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Human leucocyte antigen testing is potentially valuable in many countries to facilitate early recognition of patient susceptibility to SCARs.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in an ethnically diverse Malaysian population.
  
  
  METHODS
  A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed epilepsy among adults: (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. Base-case analysis and sensitivity analyses were performed over a lifetime time horizon. Incremental cost-effectiveness ratios were calculated.
  
  
  RESULTS
  Both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared with current practice, universal HLA-B*15:02 screening resulted in a loss of 0·0255 quality-adjusted life years (QALYs) at an additional cost of 707 U.S. dollars (USD); VPA prescribing resulted in a loss of 0·2622 QALYs at an additional cost of USD 4127, owing to estimated differences in antiepileptic treatment efficacy.
  
  
  CONCLUSIONS
  Universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia. However, with the emergence of an ethnically diverse population in many other countries, this may render HLA-B*15:02 screening a viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.
authors.affiliation: School of Pharmacy, Monash University Malaysia, Malaysia.
authors.forename: H Y
authors.initials: HY
authors.lastname: Chong
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: Z
authors.initials: Z
authors.lastname: Mohamed
authors.affiliation: Department of Dermatology, University Malaya Medical Center, Malaysia.
authors.forename: L L
authors.initials: LL
authors.lastname: Tan
authors.affiliation: School of Pharmacy, Monash University Malaysia, Malaysia.
authors.forename: D B C
authors.initials: DBC
authors.lastname: Wu
authors.affiliation: Department of Pharmacy, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: F H
authors.initials: FH
authors.lastname: Shabaruddin
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: M
authors.initials: M
authors.lastname: Dahlui
authors.affiliation: Department of Pharmacology, Faculty of Medicine, University of Malaya, Malaysia.
authors.forename: Y D
authors.initials: YD
authors.lastname: Apalasamy
authors.affiliation: Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA, U.S.A.
authors.forename: S R
authors.initials: SR
authors.lastname: Snyder
authors.affiliation: Genomic Medicine Institute, Geisinger Health System, Danville, PA, U.S.A.
authors.forename: M S
authors.initials: MS
authors.lastname: Williams
authors.affiliation: Department of Epidemiology and Health Services Research, Geisinger Health System, Danville, PA, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Hao
authors.affiliation: Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, U.S.A.
authors.forename: L H
authors.initials: LH
authors.lastname: Cavallari
authors.affiliation: School of Pharmacy, Monash University Malaysia, Malaysia.|Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Malaysia.|Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Pharmacy, University of Wisconsin, Madison, WI, U.S.A.
authors.forename: N
authors.initials: N
authors.lastname: Chaiyakunapruk
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects*; D044466:Asian People / Q000208:ethnology; D002220:Carbamazepine / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004526:Efficiency; D004827:Epilepsy / Q000188:drug therapy / Q000208:ethnology; D059910:HLA-B15 Antigen / Q000378:metabolism*; D006801:Humans; D008296:Malaysia / Q000208:ethnology; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013262:Stevens-Johnson Syndrome / Q000191:economics / Q000208:ethnology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; C483536:HLA-B*15:02 antigen; D059910:HLA-B15 Antigen; D002220:Carbamazepine