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PLoS One. 2014 May 7;9(5):e96990. doi: 10.1371/journal.pone.0096990. eCollection 2014.

Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.

Author information

1
Department of Medicine, The University of Melbourne, Parkville, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia.
2
Department of Medicine, The University of Melbourne, Parkville, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia; Melbourne EpiCentre, Royal Melbourne Hospital, Parkville, Australia.
3
Department of Medicine, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.

Abstract

OBJECTIVES:

We evaluated the cost and efficiency of routine HLA-B*15 ∶ 02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.

METHODS:

Data were extracted from patients who commenced CBZ as the first-ever AED treatment or tested for HLA-B*15 ∶ 02 allele in three years before policy implementation (pre-policy: 16 September 2005 to 15 September 2008) and three years after (post-policy: 16 September 2008 to 15 September 2011). Using published unit costs, we estimated the cost of screening by comparing the costs to prevent and treat CBZ-SJS/TEN. We compared the number of person-tests needed and the cost to prevent resultant death with cancer screening programs.

RESULTS:

The number of screening tests needed to prevent one case of CBZ-SJS/TEN was 442, and to prevent one resultant death was 1,474 to 8,840. The screening cost was $332 per person, of which 42% was attributed to an additional consultation to review result and prescribe appropriate medication. HLA-B*15 ∶ 02 screening expended $146,749 to prevent a case of CBZ-SJS/TEN, and $489,386- $2,934,986 to prevent a resultant death. The corresponding numbers of tests and costs for mammography and Pap smear to prevent death due to breast and cervical cancers were 7,150 and 7,000, and $614,900 and $273,000, respectively. Comparing to the SJS/TEN treatment cost, HLA-B*15 ∶ 02 screening would become cost saving if a point-of-care test of less than $37 was available.

CONCLUSIONS:

HLA-B*15 ∶ 02 screening is as efficient as mammography and Pap smear in preventing death. Development of point-of-care testing will vastly improve efficiency.

PMID:
24806465
PMCID:
PMC4013087
DOI:
10.1371/journal.pone.0096990
[Indexed for MEDLINE]
Free PMC Article

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