Cost‐effectiveness of screening for HLA‐A*31:01 prior to initiation of carbamazepine in epilepsy

Abstract

SUMMARYObjective: Carbamazepine causes severe cutaneous adverse drug reactions that may be predicted by the presence of the HLA-A*31:01 allele in northern European populations. There is uncertainty as to whether routine testing of patients with epilepsy is cost-effective. We conducted an economic evaluation of HLA-A*31:01 testing from the perspective of the National Health Service (NHS) in the United Kingdom. Methods: A short-term, decision analytic model was developed to estimate the outcomes and costs associated with a policy of routine testing (with lamotrigine prescribed for patients who test positive) versus the current standard of care, which is carbamazepine prescribed without testing. A Markov model was used to estimate total costs and quality-adjusted life-years (QALYs) over a lifetime to account for differences in drug effectiveness and the long-term consequences of adverse drug reactions. Results: Testing reduced the expected rate of cutaneous adverse drug reactions from 780 to 700 per 10,000 patients. The incremental cost-effectiveness ratio for pharmacogenetic testing versus standard care was £12,808 per QALY gained. The probability of testing being cost-effective at a threshold of £20,000 per QALY was 0.80, but the results were sensitive to estimated remission rates for alternative antiepileptic drugs (AEDs). Significance: Routine testing for HLA-A*31:01 in order to reduce the incidence of cutaneous adverse drug reactions in patients being prescribed carbamazepine for epilepsy is likely to represent a cost-effective use of health care resources.

Pharmacogenomics in epilepsy

“…HLA-A*31:01 has been associated with increased risk of carbamazepine-induced hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions, among subjects of European ancestry and in the Japanese population [172] , [173] . Recent economic modelling suggested that routine testing for HLA-A*31:01 in order to reduce the incidence of cutaneous adverse drug reactions in patients being prescribed carbamazepine for epilepsy is likely to represent a cost-effective use of health care resources [174] .…”

Carbamazepine-Mediated Adverse Drug Reactions: CBZ-10,11-epoxide but Not Carbamazepine Induces the Alteration of Peptides Presented by HLA-B∗15:02

“…This method allowed for the first time deep insight in the mechanism that triggers the T cell responses following CBZ application. Understanding the pathogenesis of life-threatening CBZ hypersensitivity in HLA-B∗15:02 carriers would support medication safety and cost-effective personalized treatment [ 64 ].…”

Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany

“…The cost-effectiveness of pharmacogenetics testing in the treatment of epilepsy was evaluated in three studies. The latest study from Plumpton et al [ 50 ] focused on the HLA*A*31:01 allele screening test. An ICER of £37,314 (US$53,674) per cutaneous avoided ADR for a prior HLA*A*31:01 allele test and carbamazepine (CBZ) administration following the test result was calculated.…”