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Economic Efficiency of Genetic Screening to Inform the Use of Abacavir Sulfate in the Treatment of HIV

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  • Teresa Kauf
  • Raymond Farkouh
  • Stephanie Earnshaw
  • Maria Watson
  • Penny Maroudas
  • Mike Chambers

Abstract

Background: Abacavir sulfate (abacavir) is associated with a hypersensitivity reaction (HSR) that affects 5–8% of patients. While serious complications are rare, failure to identify it, or abacavir re-challenge following HSR, can be fatal. Genetic screening for HLA-B*5701 can identify patients who are likely to experience an HSR and reduces the incidence of the reaction. Objective: We assessed the intrinsic and practical value, from the US healthcare system perspective, of prospective HLA-B*5701 screening among a population of antiretroviral-naive patients without elevated risk factors for cardiovascular disease, plasma HIV RNA >100 000 copies/mL, or preexisting renal insufficiency. Methods: Two approaches were used to evaluate the costs and benefits of prospective screening. First, the efficiency of HLA-B*5701 screening compared with no screening prior to abacavir initiation (intrinsic value of screening) was evaluated using a 60-day decision-tree model. Next, the practical value of screening was assessed using a lifetime discrete-event simulation model that compared HLA-B*5701 screening prior to abacavir use versus initiation with a tenofovir-containing regimen. Screening-effectiveness parameters were taken from an open-label trial that incorporated screening prior to abacavir initiation and other published studies. Treatment efficacy was derived from clinical trials. Modelling assumptions, costs ($US, year 2007 values) and other parameters were derived from published sources, primary data analysis and expert opinion. Multiple one-way sensitivity and scenario analyses were performed to assess parameter uncertainty. The primary outcome measure for the short-term screening versus no screening analysis was cost per patient. For the long-term analysis, outcomes were presented as QALYs. Costs and effects were discounted at 3% per year. Results: Over the first 60 days of treatment, prospective screening prior to abacavir initiation cost an additional $US17 per patient and avoided 537 HSRs per 10 000 patients. The per-patient cost of screening was sensitive to the cost of the genetic test, HSR costs and screening performance. In the lifetime model, screening-informed abacavir use was more effective and less costly than initiation with a tenofovir-containing regimen in the base case and in sensitivity analyses. Conclusions: Our results suggest that prospective HLA-B*5701 screening prior to abacavir initiation produces cost savings and should become a standard component of HIV care. Copyright Adis Data Information BV 2010

Suggested Citation

  • Teresa Kauf & Raymond Farkouh & Stephanie Earnshaw & Maria Watson & Penny Maroudas & Mike Chambers, 2010. "Economic Efficiency of Genetic Screening to Inform the Use of Abacavir Sulfate in the Treatment of HIV," PharmacoEconomics, Springer, vol. 28(11), pages 1025-1039, November.
  • Handle: RePEc:spr:pharme:v:28:y:2010:i:11:p:1025-1039
    DOI: 10.2165/11535540-000000000-00000
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    References listed on IDEAS

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    1. Chaim M. Bell & Richard H. Chapman & Patricia W. Stone & Eileen A. Sandberg & Peter J. Neumann, 2001. "An Off-the-Shelf Help List," Medical Decision Making, , vol. 21(4), pages 288-294, August.
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    Cited by:

    1. Gagliardi, Dimitri & Ramlogan, Ronnie & Navarra, Pierluigi & Dello Russo, Cinzia, 2018. "Diffusion of complementary evolving pharmaceutical innovations: The case of Abacavir and its pharmacogenetic companion diagnostic in Italy," Technological Forecasting and Social Change, Elsevier, vol. 134(C), pages 223-233.
    2. Elizabeth J J Berm & Margot de Looff & Bob Wilffert & Cornelis Boersma & Lieven Annemans & Stefan Vegter & Job F M van Boven & Maarten J Postma, 2016. "Economic Evaluations of Pharmacogenetic and Pharmacogenomic Screening Tests: A Systematic Review. Second Update of the Literature," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-22, January.

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