T 01: Cost Effectiveness Analysis of HLA-B5801 Genotyping in the Treatment of Gout Patients with Chronic Renal Insufficiency
Fellow, Division of Clinical Pharmacology
Chonnam National University Hospital Korea, Republic of
1. HLA–B5801 genotyping is cost-effective in allopurinol in gout patients with chronic renal insufficiency in Korea.
2. Clinicians treating Korean patients with gout and renal insufficiency should consider HLA–B5801 genotyping to reduce allopurinol-induced severe cutaneous adverse reactions.
A decision model was employed to compare the cost and outcomes of treatment using HLA-B5801 genotyping with that of a conventional strategy in gout patients with CKD. The costs were obtained from SCAR patients. Outcomes were measured as an expected cost and an incremental cost-effectiveness ratio.
In the base scenario, treatment informed by HLA–B5801 genotyping cost 154,000 Korean won ($138) less than conventional treatment and was associated with a greater probability of continued gout treatment without SCARs. The total expected costs of conventional treatment and treatment following HLA–B5801 genotyping were 1,332,000 Korean won ($1,193) and 1,178,000 Korean won ($1,055), respectively. The probability of SCARs during conventional treatment was 2.19%, whereas no SCARs occurred in patients whose treatment was informed by HLA–B5801 genotyping. Consequently, the probabilities of continued gout treatment without SCARs in patients treated uniformly with allopurinol and those treated based on HLA–B5801 genotyping results were 97.81% and 100%, respectively. Furthermore, patients with a probable death rate of 0.59% in the conventional method survived without SCARs following the genotyping treatment. Therefore, treatment informed by HLA–B5801 genotyping was superior to conventional treatment, considering it was less costly and more effective. Until the prevalence of HLA–B5801 decreased to 3.81%, the genotype-based treatment was more cost beneficial than conventional treatment.
We conducted the first investigation of the cost-effectiveness of urate-lowering treatment with allopurinol based on HLA–B5801 genotyping in Korean gout patients with chronic renal insufficiency. 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. The results of our study provide important information that should help prevent unnecessary adverse reactions and SCARs-related deaths and inform the development of guidelines for clinical practice and health care policy.