PMID- 24732692
OWN - NLM
STAT- MEDLINE
DCOM- 20150115
LR  - 20240314
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 9
IP  - 4
DP  - 2014
TI  - Cost-effectiveness analysis of HLA-B*5801 testing in preventing 
      allopurinol-induced SJS/TEN in Thai population.
PG  - e94294
LID - 10.1371/journal.pone.0094294 [doi]
LID - e94294
AB  - BACKGROUND: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), 
      caused by allopurinol therapy, are strongly associated with the human leukocyte 
      antigen (HLA), HLA-B*5801. Identification of HLA-B*5801 genotype before 
      prescribing allopurinol offers the possibility of avoiding allopurinol-induced 
      SJS/TEN. As there is a paucity of evidence about economic value of such testing, 
      this study aims to determine the cost-effectiveness of HLA-B*5801 testing 
      compared with usual care (no genetic testing) before allopurinol administration 
      in Thailand. METHODS AND FINDING: A decision analytical and Markov model was used 
      to estimate life time costs and outcomes represented as quality adjusted life 
      years (QALYs) gained. The model was populated with relevant information of the 
      association between gene and allopurinol-induced SJS/TEN, test characteristics, 
      costs, and epidemiologic data for Thailand from a societal perspective. Input 
      data were obtained from the literature and a retrospective database analysis. The 
      results were expressed as incremental cost per QALY gained. A base-case analysis 
      was performed for patients at age 30. A series of sensitivity analyses including 
      scenario, one-way, and probabilistic sensitivity analyses were constructed to 
      explore the robustness of the findings. Based on a hypothetical cohort of 1,000 
      patients, the incremental total cost was 923,919 THB (USD 29,804) and incremental 
      QALY was 5.89 with an ICER of 156,937.04 THB (USD 5,062) per QALY gained. The 
      cost of gout management, incidence of SJS/TEN, case fatality rate of SJS/TEN, and 
      cost of genetic testing are considered very influential parameters on the 
      cost-effectiveness value of HLA-B*5801 testing. CONCLUSIONS: The genetic testing 
      for HLA-B*5801 before allopurinol administration is considered a highly potential 
      cost-effective intervention in Thailand. The findings are sensitive to a number 
      of factors. In addition to cost-effectiveness findings, consideration of other 
      factors including ethical, legal, and social implications is needed for an 
      informed policy decision making.
FAU - Saokaew, Surasak
AU  - Saokaew S
AD  - Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy 
      Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, 
      Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), 
      School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; 
      Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University 
      of Utah, Salt Lake City, Utah, United States of America.
FAU - Tassaneeyakul, Wichittra
AU  - Tassaneeyakul W
AD  - Department of Pharmacology, Faculty of Medicine, Khon KaenUniversity, Khon Kaen, 
      Thailand; Research and Diagnostic Center for Emerging Infectious Diseases, Khon 
      Kaen University, Khon Kaen, Thailand.
FAU - Maenthaisong, Ratree
AU  - Maenthaisong R
AD  - Clinical Pharmacy Research Unit, Department of Clinical Pharmacy, Faculty of 
      Pharmacy, Mahasarakham University, Mahasarakham, Thailand.
FAU - Chaiyakunapruk, Nathorn
AU  - Chaiyakunapruk N
AD  - 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, Wisconsin, United 
      States of America; School of Pharmacy, Monash University Malaysia, Bandar Sunway, 
      Selangor, Malaysia; School of Population Health, University of Queensland, 
      Brisbane, Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140414
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (HLA-B Antigens)
RN  - 63CZ7GJN5I (Allopurinol)
SB  - IM
MH  - Allopurinol/*adverse effects
MH  - *Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Genetic Testing/*economics
MH  - HLA-B Antigens/*economics/*genetics
MH  - Humans
MH  - Stevens-Johnson Syndrome/economics/*genetics/*prevention & control
MH  - Thailand
MH  - Treatment Outcome
PMC - PMC3986079
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2014/04/16 06:00
MHDA- 2015/01/16 06:00
PMCR- 2014/04/14
CRDT- 2014/04/16 06:00
PHST- 2013/09/18 00:00 [received]
PHST- 2014/03/15 00:00 [accepted]
PHST- 2014/04/16 06:00 [entrez]
PHST- 2014/04/16 06:00 [pubmed]
PHST- 2015/01/16 06:00 [medline]
PHST- 2014/04/14 00:00 [pmc-release]
AID - PONE-D-13-38493 [pii]
AID - 10.1371/journal.pone.0094294 [doi]
PST - epublish
SO  - PLoS One. 2014 Apr 14;9(4):e94294. doi: 10.1371/journal.pone.0094294. eCollection 
      2014.