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Background: A strong association has been documented between HLA-B*15:02 and carbamazepine-induced severe cutaneous adverse reactions (SCARs) in Asians. Human leucocyte antigen testing is potentially valuable in many countries to facilitate early recognition of patient susceptibility to SCARs.

Objectives: To determine the cost-effectiveness of universal HLA-B*15:02 screening in preventing carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in an ethnically diverse Malaysian population.

Methods: A hybrid model of a decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed epilepsy among adults: (i) carbamazepine initiation without HLA-B*15:02 screening (current practice); (ii) universal HLA-B*15:02 screening prior to carbamazepine initiation; and (iii) alternative treatment [sodium valproate (VPA)] prescribing without HLA-B*15:02 screening. Base-case analysis and sensitivity analyses were performed over a lifetime time horizon. Incremental cost-effectiveness ratios were calculated.

Results: Both universal HLA-B*15:02 screening and VPA prescribing were dominated by current practice. Compared with current practice, universal HLA-B*15:02 screening resulted in a loss of 0·0255 quality-adjusted life years (QALYs) at an additional cost of 707 U.S. dollars (USD); VPA prescribing resulted in a loss of 0·2622 QALYs at an additional cost of USD 4127, owing to estimated differences in antiepileptic treatment efficacy.

Conclusions: Universal HLA-B*15:02 screening is unlikely to be a cost-effective intervention in Malaysia. However, with the emergence of an ethnically diverse population in many other countries, this may render HLA-B*15:02 screening a viable intervention when an increasing proportion of the population is at risk and an equally effective yet safer antiepileptic drug is available.

Titel:	Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia.
Autor/in / Beteiligte Person:	Chong, HY ; Mohamed, Z ; Tan, LL ; Wu, DBC ; Shabaruddin, FH ; Dahlui, M ; Apalasamy, YD ; Snyder, SR ; Williams, MS ; Hao, J ; Cavallari, LH ; Chaiyakunapruk, N
Zeitschrift:	The British journal of dermatology, Jg. 177 (2017-10-01), Heft 4, S. 1102-1112
Veröffentlichung:	2023- : Oxford : Oxford University Press ; <i>Original Publication</i>: Oxford [etc.] Published for the British Association of Dermatologists by Blackwell Scientific Publications [etc.], 2017
Medientyp:	academicJournal
ISSN:	1365-2133 (electronic)
DOI:	10.1111/bjd.15498
Schlagwort:	Adolescent Adult Asian People ethnology Cost-Benefit Analysis Efficiency Epilepsy drug therapy Epilepsy ethnology Humans Malaysia ethnology Markov Chains Mass Screening economics Middle Aged Quality-Adjusted Life Years Stevens-Johnson Syndrome economics Stevens-Johnson Syndrome ethnology Young Adult Anticonvulsants adverse effects Carbamazepine adverse effects HLA-B15 Antigen metabolism Stevens-Johnson Syndrome prevention & control
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Multicenter Study Language: English [Br J Dermatol] 2017 Oct; Vol. 177 (4), pp. 1102-1112. <i>Date of Electronic Publication: </i>2017 Sep 21. MeSH Terms: Anticonvulsants / adverse effects ; Carbamazepine / adverse effects ; HLA-B15 Antigen / metabolism ; Stevens-Johnson Syndrome / prevention & control ; Adolescent ; Adult ; Asian People / ethnology ; Cost-Benefit Analysis ; Efficiency ; Epilepsy / drug therapy ; Epilepsy / ethnology ; Humans ; Malaysia / ethnology ; Markov Chains ; Mass Screening / economics ; Middle Aged ; Quality-Adjusted Life Years ; Stevens-Johnson Syndrome / economics ; Stevens-Johnson Syndrome / ethnology ; Young Adult Comments: Comment in: Br J Dermatol. 2017 Oct;177(4):904-905. (PMID: 29052888) References: Epilepsia. 2015 Apr;56(4):556-63. (PMID: 26046144) ; Neurology. 2012 Sep 18;79(12):1259-67. (PMID: 22955130) ; Epilepsia. 2000 Nov;41(11):1469-73. (PMID: 11077462) ; Epilepsia. 2014 Nov;55(11):e120-4. (PMID: 25266342) ; Acta Derm Venereol. 2016 May;96(4):525-9. (PMID: 26582440) ; Orphanet J Rare Dis. 2017 Jan 18;12(1):14. (PMID: 28100272) ; Cochrane Database Syst Rev. 2000;(3):CD001030. (PMID: 10908558) ; Curr Opin Ophthalmol. 2016 Nov;27(6):522-529. (PMID: 27585215) ; Int J Health Policy Manag. 2021 Nov 01;10(11):670-672. (PMID: 34634892) ; JAMA Dermatol. 2013 Sep;149(9):1025-32. (PMID: 23884208) ; PLoS One. 2014 Apr 14;9(4):e94294. (PMID: 24732692) ; Value Health. 2012 Jan-Feb;15(1 Suppl):S85-90. (PMID: 22265073) ; Ocul Surf. 2016 Apr;14(2):168-88. (PMID: 26882981) ; Med Care. 2012 May;50(5):452-9. (PMID: 22002647) ; Burns. 2016 Feb;42(1):20-27. (PMID: 25865527) ; Trials. 2007 Nov 05;8:34. (PMID: 17983480) ; Allergy. 2007 May;62(5):527-31. (PMID: 17313402) ; Pharm World Sci. 2008 Jun;30(3):281-6. (PMID: 18204974) ; J Hum Genet. 2013 Jun;58(6):317-26. (PMID: 23635947) ; Health Technol Assess. 2007 Oct;11(37):iii-iv, ix-x, 1-134. (PMID: 17903391) ; Asia Pac Allergy. 2013 Oct;3(4):215-23. (PMID: 24260726) ; J Invest Dermatol. 2008 Jan;128(1):35-44. (PMID: 17805350) ; Lancet Neurol. 2006 Jun;5(6):481-7. (PMID: 16713919) ; Hum Immunol. 2001 Jun;62(6):645-50. (PMID: 11390040) ; N Engl J Med. 1994 Nov 10;331(19):1272-85. (PMID: 7794310) ; Cochrane Database Syst Rev. 2015 Feb 11;(2):CD001902. (PMID: 25922863) ; Epilepsy Behav. 2013 Apr;27(1):130-4. (PMID: 23416283) ; Epilepsia. 1980 Aug;21(4):399-412. (PMID: 7398606) ; CNS Drugs. 2004;18(4):201-12. (PMID: 15015901) ; Crit Care Med. 2011 Jun;39(6):1521-32. (PMID: 21358399) ; J Neurol Neurosurg Psychiatry. 1999 May;66(5):636-40. (PMID: 10209177) ; Pharmacogenomics. 2008 Oct;9(10):1543-6. (PMID: 18855540) ; N Engl J Med. 1995 Dec 14;333(24):1600-7. (PMID: 7477195) ; Neurology. 2011 Dec 6;77(23):2025-33. (PMID: 22116946) ; Epilepsia. 2013 Sep;54(9):1628-38. (PMID: 23895569) ; Pharmacoeconomics. 2016 Aug;34(8):771-93. (PMID: 26984520) ; Epilepsia. 1997 Oct;38(10):1062-8. (PMID: 9579951) ; Int J Dermatol. 2011 Feb;50(2):221-4. (PMID: 21244392) ; Pharmacoeconomics. 2003;21(1):39-48. (PMID: 12484802) ; Health Policy. 1990 Dec;16(3):199-208. (PMID: 10109801) ; Clin Pharmacol Ther. 2013 Sep;94(3):324-8. (PMID: 23695185) ; Indian J Dermatol Venereol Leprol. 2012 Nov-Dec;78(6):734-9. (PMID: 23075643) ; Nucleic Acids Res. 2011 Jan;39(Database issue):D913-9. (PMID: 21062830) ; Orphanet J Rare Dis. 2010 Dec 16;5:39. (PMID: 21162721) ; Ann Neurol. 2001 Mar;49(3):336-44. (PMID: 11261508) Grant Information: U01 HG007269 United States HG NHGRI NIH HHS; UL1 TR001427 United States TR NCATS NIH HHS Substance Nomenclature: 0 (Anticonvulsants) ; 0 (HLA-B*15:02 antigen) ; 0 (HLA-B15 Antigen) ; 33CM23913M (Carbamazepine) Entry Date(s): Date Created: 20170328 Date Completed: 20180618 Latest Revision: 20240327 Update Code: 20240327 PubMed Central ID: PMC5617756

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Is universal HLA-B*15:02 screening a cost-effective option in an ethnically diverse population? A case study of Malaysia.