Economic evaluation of multiple-pharmacogenes testing for the prevention of adverse drug reactions in people living with HIV

Turongkaravee, S., Praditsitthikorn, N., Ngamprasertchai, T., Jittikoon, J., Mahasirimongkol, S., Sukasem, C., Udomsinprasert, W., Wu, O. and Chaikledkaew, U. (2022) Economic evaluation of multiple-pharmacogenes testing for the prevention of adverse drug reactions in people living with HIV. ClinicoEconomics and Outcomes Research, 14, pp. 447-463. (doi: 10.2147/CEOR.S366906) (PMID:35832304) (PMCID:PMC9272846)

Abstract

Purpose: Pharmacogenetics (PGx) testing is one of the methods for determining whether individuals are at risk of adverse drug reactions (ADRs). It has been reported that multiple-PGx testing, a sequencing technology, has a higher predictive value than single-PGx testing. Therefore, this study aimed to determine the most cost-effective PGx testing strategies for preventing drug-induced serious ADRs in human immunodeficiency virus (HIV)-infected patients. Patients and Methods: Potential strategies, including 1) single-PGx esting (ie, HLA-B*57:01 testing before prescribing abacavir, HLA-B*13:01 testing before prescribing co-trimoxazole and dapsone, and NAT2 testing before prescribing isoniazid) and 2) multiple-PGx testing as a combination of four single-gene PGx tests in one panel, were all compared to no PGx testing (current practice). To evaluate total cost in Thai baht (THB) and quality-adjusted life years (QALYs) for each strategy-based approach to a societal perspective, a hybrid decision tree and Markov model was constructed. Incremental cost-effectiveness ratios (ICERs) were estimated. Uncertainty, threshold, and scenario analyses were all performed. Results: Before prescribing HIV therapy, providing single or multiple-PGx testing might save roughly 68 serious ADRs per year, and the number needed to screen (NNS) to avoid one serious ADR was 40. Consequently, approximately 35% and 40% of the cost of ADR treatment could be avoided by the implementation of single- and multiple-PGx testing, respectively. Compared with no PGx testing strategy, the ICERs were 146,319 THB/QALY gained for single-PGx testing and 152,014 THB/QALY gained for multiple-PGx testing. Moreover, the probability of multiple-PGx testing being cost-effective was 45% at the Thai willingness to pay threshold of 160,000 THB per QALY. Threshold analyses showed that multiple-PGx testing remained cost-effective under the range of cost, sensitivity at 0.95– 1.00 and specificity at 0.98– 1.00. Conclusion: Single and multiple-PGx testing might be cost-effective options for reducing the incidence of drug-induced serious ADRs in people living with HIV.

• Item Type: Articles
• Additional Information: This work is a part of a study in Doctor of Philosophy program in Social, Economic and Administrative Pharmacy (SEAP), Faculty of Pharmacy, Mahidol University, Bangkok. Besides, this study was supported by grants from the International Research Network-The Thailand Research Fund (IRN60W003) and Health Systems Research Institute (HSRI61-080), Thailand.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wu, Professor Olivia
• Authors: Turongkaravee, S., Praditsitthikorn, N., Ngamprasertchai, T., Jittikoon, J., Mahasirimongkol, S., Sukasem, C., Udomsinprasert, W., Wu, O., and Chaikledkaew, U.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: ClinicoEconomics and Outcomes Research
• Publisher: Dove Medical Press
• ISSN: 1178-6981
• ISSN (Online): 1178-6981
• Published Online: 07 July 2022
• Copyright Holders: Copyright © 2022 Turongkaravee et al.
• First Published: First published in ClinicoEconomics and Outcomes Research 14: 447-463
• Publisher Policy: Reproduced under a Creative Commons License