PMID- 23895569
OWN - NLM
STAT- MEDLINE
DCOM- 20131113
LR  - 20131121
IS  - 1528-1167 (Electronic)
IS  - 0013-9580 (Linking)
VI  - 54
IP  - 9
DP  - 2013 Sep
TI  - Economic evaluation of HLA-B*15:02 screening for carbamazepine-induced severe 
      adverse drug reactions in Thailand.
PG  - 1628-38
LID - 10.1111/epi.12325 [doi]
AB  - PURPOSE: There is strong evidence of an association between the presence of the 
      human leukocyte antigen (HLA)-B*15:02 and two severe adverse drug 
      reactions-Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)-in 
      patients taking carbamazepine (CBZ), a common treatment for patients with 
      epilepsy and neuropathic pain. As a result, there are calls for all patients that 
      are due to undergo CBZ therapy to be screened for this genetic marker before 
      commencing their therapy. This study aims to determine the value for money of 
      HLA-B*15:02 screening compared to the following: (1) administering CBZ therapy 
      without conducting patient screening, and (2) not prescribing CBZ but alternative 
      drugs that are less likely to result in severe reactions, but that come at a 
      higher cost. METHOD: An economic evaluation was carried out by using a decision 
      tree and Markov models to examine the cost-utility of providing HLA-B*15:02 
      screening for all patients with either newly diagnosed epilepsy or neuropathic 
      pain in the Thai setting. All transitional probabilities were derived from the 
      national and international literature. The majority of the data on direct medical 
      care costs were collected from 10 community, provincial, and regional hospitals 
      throughout Thailand. Direct non-medical cost and health-related quality of life 
      (HRQoL) data were obtained from interviews that were conducted with 33 patients, 
      some of whom had experienced severe drug reactions. KEY FINDINGS: The incremental 
      cost-effectiveness ratio (ICER) of adopting a universal HLA-B*15:02 screening 
      policy was estimated at 222,000 Thai baht, THB/quality-adjusted life year (QALY) 
      gained for epilepsy patients and 130,000 THB/QALY gained for patients with 
      neuropathic pain. Furthermore, we found that 343 patients need to be tested for 
      HLA-B*15:02 allele to prevent one case of SJS/TEN. SIGNIFICANCE: Universal 
      HLA-B*15:02 screening represents good value for the money in terms of preventing 
      SJS/TEN in CBZ-treated patients with neuropathic pain at the Thai ceiling ratio 
      of 120,000 THB/QALY gained. However, the prevalence of CBZ-induced SJS/TEN in the 
      Thai population and the positive predictive value (PPV) are major factors that 
      influence the cost-effectiveness of HLA-B*15:02 screening. Therefore, an active 
      surveillance system to make a more accurate assessment of the prevalence 
      CBZ-induced SJS/TEN in the Thai population would enhance the generalizability of 
      the results.
CI  - Wiley Periodicals, Inc. (c) 2013 International League Against Epilepsy.
FAU - Rattanavipapong, Waranya
AU  - Rattanavipapong W
AD  - Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, 
      Thailand.
FAU - Koopitakkajorn, Tanunya
AU  - Koopitakkajorn T
FAU - Praditsitthikorn, Naiyana
AU  - Praditsitthikorn N
FAU - Mahasirimongkol, Surakameth
AU  - Mahasirimongkol S
FAU - Teerawattananon, Yot
AU  - Teerawattananon Y
LA  - eng
PT  - Journal Article
DEP - 20130729
PL  - United States
TA  - Epilepsia
JT  - Epilepsia
JID - 2983306R
RN  - 0 (Anticonvulsants)
RN  - 0 (HLA-B15 Antigen)
RN  - 33CM23913M (Carbamazepine)
SB  - IM
MH  - Adult
MH  - Anticonvulsants/*adverse effects/therapeutic use
MH  - Carbamazepine/*adverse effects/therapeutic use
MH  - Drug-Related Side Effects and Adverse Reactions/*economics
MH  - Epilepsy/drug therapy/immunology
MH  - HLA-B15 Antigen/*analysis
MH  - Humans
MH  - Middle Aged
MH  - Risk Factors
MH  - Stevens-Johnson Syndrome/genetics
MH  - Thailand
MH  - Young Adult
OTO - NOTNLM
OT  - Cost-utility analysis
OT  - HLA-B*15:02
OT  - Stevens-Johnson syndrome
OT  - Toxic epidermal necrolysis
EDAT- 2013/07/31 06:00
MHDA- 2013/11/14 06:00
CRDT- 2013/07/31 06:00
PHST- 2013/06/18 00:00 [accepted]
PHST- 2013/07/31 06:00 [entrez]
PHST- 2013/07/31 06:00 [pubmed]
PHST- 2013/11/14 06:00 [medline]
AID - 10.1111/epi.12325 [doi]
PST - ppublish
SO  - Epilepsia. 2013 Sep;54(9):1628-38. doi: 10.1111/epi.12325. Epub 2013 Jul 29.