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. 2021 Aug;21(4):476-483.
doi: 10.1038/s41397-021-00225-9. Epub 2021 Apr 6.

Cost-effectiveness analysis of genotyping for HLA-B*15:02 in Indonesian patients with epilepsy using a generic model

Rika Yuliwulandari  1   2 , Jae Gook Shin  3   4 , Erna Kristin  5 , Fransiscus D Suyatna  6 , Iwan Dwi Prahasto  5 , Kinasih Prayuni  7 , Surakameth Mahasirimongkol  8 , Larisa H Cavallari  9 , Christina Mitropoulou  10 , George P Patrinos  11   12 , Jing Hao  13 , Marc S Williams  14 , Susan R Snyder  15
Affiliations

Cost-effectiveness analysis of genotyping for HLA-B*15:02 in Indonesian patients with epilepsy using a generic model

Rika Yuliwulandari et al. Pharmacogenomics J. 2021 Aug.

Abstract

Carbamazepine (CBZ)-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are strongly associated with the HLA-B*15:02 allele. Screening HLA-B*15:02 before CBZ administration might prevent CBZ-induced SJS/TEN by enabling clinicians to prescribe alternative therapy for positive patients. Similar to other Southeastern Asian countries, HLA-B*15:02 is highly prevalent in Indonesia. Therefore, we assessed the economic value of HLA-B*15:02 screening before CBZ prescription to patients with epilepsy in Indonesia. A generic cost-effectiveness model and decision support tool, developed to enable users to perform an initial cost-effectiveness analysis from a healthcare provider/payer perspective, were used to assess the value of HLA-B*15:02 genotyping. The incremental cost-effectiveness ratio of adopting universal HLA-B*15:02 screening was 656,444,671 Indonesian Rupiah (IDR)/quality-adjusted life year (QALY) gained for patients compared with 2,634,975,574 IDR/QALY gained for providing valproic acid (alternative drug) without screening. Thus, neither HLA-B*15:02 screening nor substitution with VPA meets the Indonesian threshold for cost effectiveness. However, the improved outcomes with this test in other Asian countries may inform the desirability of implementation in Indonesia even with suboptimal cost-effectiveness.

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Conflict of interest statement

Conflicts of Interests

The authors declare no conflict of interest regarding the information presented in this manuscript.

Figures

Fig 1.
Fig 1.
Decision tree model showing the three potential strategies for the treatment of patients with epilepsy.
Fig 2.
Fig 2.. Markov model showing the three potential outcomes for patients treated with CBZ or VPA
A. Patients that developed SJS/TEN following CBZ treatment B. Patients that did not develop SJS/TEN following treatment with CBZ or VPA Abbreviations: SJS: Steven–Johnson Syndrome; TEN: toxic epidermal necrolysis; CBZ: carbamazepine; VPA: valproic acid.
Fig 3.
Fig 3.
Cost-effectiveness acceptability curves: the likelihood that each strategy will be acceptable to a decision maker, ultimately influencing their willingness to pay.
See this image and copyright information in PMC

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