Background Allopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare, but cause high rates of morbidity and mortality. Studies have shown that the HLA-B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guideline recommends that, prior to treatment with allopurinol, the HLA–B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown.
Objectives In this study, we evaluated the cost-effectiveness of HLA-B5801 genotyping for treatment of gout in patients with chronic renal insufficiency in Korea.
Methods A decision analytic model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA-B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real SCAR patients from two tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio.
Results In the base model, the total expected cost and probability of continuation of gout treatment without SCARs with the conventional and HLA-B5801 screening strategies were US $1,193 and US $1,055, and 97.8% and 100%, respectively. The result was robust according to sensitivity analyses.
Conclusions Our model suggests that gout treatment informed by HLA-B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA-B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths.
Disclosure of Interest None declared
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