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Objective

Allopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare but cause high rates of morbidity and mortality. Studies have shown that the HLA–B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guidelines recommend that, prior to treatment with allopurinol, the HLA–B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown. This study evaluated the cost-effectiveness of HLA–B5801 genotyping for the treatment of gout in patients with chronic renal insufficiency in Korea.

Methods

A decision analytical model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA–B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real patients with SCARs from 2 tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio.

Results

In the base model, the total expected cost and probability of continuation of gout treatment without SCARs for the conventional and HLA–B5801 screening strategies were $1,193 and 97.8% and $1,055 and 100%, respectively. The results were robust according to sensitivity analyses.

Conclusion

Our model suggests that gout treatment informed by HLA–B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA–B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths.