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Cost–effectiveness analysis of genotyping for HLA-B*5801 and an enhanced safety program in gout patients starting allopurinol in Singapore

    Di Dong

    Health Services & Systems Research Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore

    ,
    Wei-Chuen Tan-Koi

    Vigilance & Compliance Branch, Health Sciences Authority, 11 Biopolis Way, #11–01, Helios, Singapore 138667, Singapore

    Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10–01, Singapore 117549, Singapore

    ,
    Gim Gee Teng

    Division of Rheumatology, National University Health System, University Medicine Cluster, Singapore

    Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

    ,
    Eric Finkelstein

    Health Services & Systems Research Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore

    &
    Cynthia Sung

    *Author for correspondence:

    E-mail Address: cynthia_sung@hsa.gov.sg

    Vigilance & Compliance Branch, Health Sciences Authority, 11 Biopolis Way, #11–01, Helios, Singapore 138667, Singapore

    Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore

    Published Online:https://doi.org/10.2217/pgs.15.125

    Aims: Allopurinol is an efficacious urate-lowering therapy (ULT), but is associated with rare serious adverse drug reactions of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with higher risk among HLA-B*5801 carriers. We assessed the cost–effectiveness of HLA-B*5801 testing, an enhanced safety program or strategies with both components. Methods: The analysis adopted a health systems perspective and considered Singaporean patients with chronic gout, over a lifetime horizon, using allopurinol or probenecid. The model incorporated SJS/TEN and gout treatment outcomes, allele frequencies, drug prices and other medical costs. Results: Based on cost–effectiveness threshold of US$50,000 per quality-adjusted life year, HLA-B*5801-guided ULT selection or enhanced safety program was not cost effective. Avoidance of ULTs was the least preferred strategy as uncontrolled gout leads to lower quality-adjusted life years and higher costs. Conclusion: The analysis underscores the need for biomarkers with higher positive predictive value for SJS/TEN, less expensive genetic tests or safety programs, or more effective gout drugs.

    .

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