HLA-B*57: 01 genotyping in the prevention of hypersensitivity to abacavir

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Abstract

Introduction

Most of the cost-effectiveness analyses are based on estimations to make decisions on the future implementation of a test. However, the model should be verified with real data to prove that previous estimations have been successfully fulfilled.

Objective

To study the economic impact of the systematic HLA-B*57:01 genotyping in preventing hypersensitivity reactions (HSRs) in the patient population of a tertiary-care hospital treated with abacavir (ABC) using retrospective data of 5 years of experience.

Methods

A retrospective study was carried out with two cohorts including 780 and 473 patients before and after the implementation of the systematic HLA-B*57:01 genotyping before ABC treatment. Cost-effectiveness analysis was carried out by the parameter ‘cost per HSR avoided’. The clinical utility of the test was verified by evaluating the differences in HSR incidence between both cohorts. Finally, a sensitivity analysis including all variables was carried out.

Results

In the population studied, systematic genotyping represents an additional cost of €306 per HSR avoided. In the sensitivity analysis, pharmacological therapy cost is the major influencing factor found in the estimation of the ‘cost per HSR avoided’. In terms of clinical utility, the incidence ratio was 0.040 (95% confidence interval 0.0009–0.2399) and statistically significant differences were found between both groups (P=1.40×10–7).

Conclusion

Retrospective data from 5 years of experience have confirmed the cost-effectiveness of the systematic genotyping in candidate patients for ABC therapy, and have shown that cost-effectiveness is a dynamic parameter closely linked to allele prevalence and pharmacological therapy costs.

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