title: Cost-effectiveness Analysis for Genotyping before Allopurinol Treatment to Prevent Severe Cutaneous Adverse Drug Reactions.
abstract: Patients with an HLA-B*58:01 allele have an increased risk of developing severe cutaneous adverse drug reactions (SCAR) when treated with allopurinol. Although one-off pharmacogenetic testing may prevent life-threatening adverse drug reactions, testing prior to allopurinol initiation incurs additional costs. The study objective was to evaluate the cost-effectiveness of HLA-B*58:01 screening compared with using other available urate-lowering agents (ULA).
  
  
  
  A decision-analytical model was used to compare direct medical costs and effectiveness [including lifetime saved, quality-adjusted life-yrs (QALY) gained] in treating new patients with the following options: (1) genetic screening followed by allopurinol prescribing for noncarriers of HLA-B*58:01, (2) prescribing benzbromarone without screening, (3) prescribing febuxostat without screening, and (4) prescribing allopurinol without screening. A 1-year time frame and third-party payer perspective were modeled for both the entire cohort (base-case) and for the subgroup of patients with chronic kidney disease (CKD).
  
  
  
  The incremental cost-effectiveness ratio of genetic screening prior to ULA therapy was estimated as New Taiwan (NT) $234,610 (US$7508) per QALY gained in the base-case cohort. For patients with CKD, it was estimated as NT$230,925 (US$7390) per QALY. The study results were sensitive to the probability of benzbromarone/febuxostat-related hypersensitivity, and a negative predicted value of genotyping.
  
  
  
  HLA-B*58:01 screening gave good value for money in preventing allopurinol-induced SCAR in patients indicated for ULA therapy. In addition to the costs of genotyping, it is important to monitor ULA safety closely in adopting HLA-B*58:01 screening in practice.
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Ching-Hua
authors.initials: CH
authors.lastname: Ke
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Chung
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Yen-Hsia
authors.initials: YH
authors.lastname: Wen
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Yaw-Bin
authors.initials: YB
authors.lastname: Huang
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chuang
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Tain
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Yu-Ching Lily
authors.initials: YL
authors.lastname: Wang
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital.
authors.forename: Cheng-Chih
authors.initials: CC
authors.lastname: Wu
authors.affiliation: From the School of Pharmacy, and Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Department of Pharmacy, Kaohsiung Medical University, Chung-Ho Memorial Hospital; Department of Pediatrics, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung; Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. chien_ning_hsu@hotmail.com.|C.H. Ke, MSc, School of Pharmacy, Kaohsiung Medical University; W.H. Chung, MD, PhD, Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.H. Wen, PhD, School of Pharmacy, Kaohsiung Medical University; Y.B. Huang, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Chung-Ho Memorial Hospital; H.Y. Chuang, MD, PhD, Department of Public Health and Center of Excellence for Environmental Medicine, Kaohsiung Medical University; Y.L. Tain, MD, PhD, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University; Y.C. Wang, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.C. Wu, MSc, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital; C.N. Hsu, PhD, School of Pharmacy, Kaohsiung Medical University, and Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital. chien_ning_hsu@hotmail.com.
authors.forename: Chien-Ning
authors.initials: CN
authors.lastname: Hsu
mesh_terms: D000493:Allopurinol / Q000009:adverse effects* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005820:Genetic Testing / Q000191:economics*; D005838:Genotype; D006073:Gout / Q000188:drug therapy* / Q000235:genetics; D006074:Gout Suppressants / Q000009:adverse effects* / Q000627:therapeutic use; D015235:HLA-B Antigens / Q000235:genetics; D006801:Humans; D010597:Pharmacogenetics
chemical_list: D006074:Gout Suppressants; D015235:HLA-B Antigens; D000493:Allopurinol
keywords: ALLOPURINOL; CHRONIC KIDNEY DISEASE; COST-EFFECTIVENESS ANALYSIS; HLA-B*58:01; SCAR