Cost-Effectiveness Analysis of HLA–B5801 Genotyping in the Treatment of Gout Patients With Chronic Renal Insufficiency in Korea
Article first published online: 27 JAN 2015
Copyright © 2015 by the American College of Rheumatology
Arthritis Care & Research
Volume 67, Issue 2, pages 280–287, February 2015
How to Cite
Park, D.-J., Kang, J.-H., Lee, J.-W., Lee, K.-E., Wen, L., Kim, T.-J., Park, Y.-W., Park, S.-H. and Lee, S.-S. (2015), Cost-Effectiveness Analysis of HLA–B5801 Genotyping in the Treatment of Gout Patients With Chronic Renal Insufficiency in Korea. Arthritis Care Res, 67: 280–287. doi: 10.1002/acr.22409
- Issue published online: 27 JAN 2015
- Article first published online: 27 JAN 2015
- Accepted manuscript online: 21 JUL 2014 12:42PM EST
- Manuscript Accepted: 15 JUL 2014
- Manuscript Received: 1 FEB 2014
- LG Life Sciences. Grant Number: IIS-2013-16
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.
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.
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.
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.