Cost‐effectiveness of screening for HLA‐B1502 prior to initiation of carbamazepine in epilepsy patients of Asian ancestry in the United States

• Published in: Epilepsia (Copenhagen) 2019-07, Vol.60 (7), p.1472-1481
• Main Authors: Choi, Hyunmi, Mohit, Babak
• Format: Article
• Language: English
• Subjects: Adult; Alleles; Anticonvulsants - adverse effects; Anticonvulsants - economics; Anticonvulsants - therapeutic use; Asian Continental Ancestry Group - genetics; Asian Continental Ancestry Group - statistics & numerical data; Asian people; Carbamazepine; Carbamazepine - adverse effects; Carbamazepine - economics; Carbamazepine - therapeutic use; cost; Cost-Benefit Analysis; cost‐effectiveness; Epilepsy; Epilepsy - drug therapy; Epilepsy - economics; Epilepsy - genetics; Etiracetam; Genetic Predisposition to Disease - genetics; genetic screening; Genetic Testing - economics; Genotype; Genotypes; Health Care Costs; Histocompatibility antigen HLA; HLA-B15 Antigen - genetics; HLA‐B1502; Humans; Markov Chains; Markov model; Minority & ethnic groups; pharmacovigilance; public health; QALY; Quality-Adjusted Life Years; Seizures; Sensitivity analysis; Skin diseases; Stevens-Johnson Syndrome - economics; Stevens-Johnson Syndrome - genetics; Stevens‐Johnson syndrome; Toxic epidermal necrolysis; United States
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/epi.16053

Objective Carbamazepine, widely used in the treatment of partial and generalized tonic–clonic seizures, has been associated with life‐threatening Stevens‐Johnson syndrome/toxic epidermal necrolysis among some Asians. The HLA‐B*1502 genotype that occurs with varying frequency among Asians is recommended for screening prior to starting carbamazepine. Our goal is to explore the cost‐effectiveness of screening for the presence of this genetic allele. Methods We constructed a Markov model in a hypothetical cohort of adult Asian patients with epilepsy in the United States being considered for carbamazepine to investigate the cost‐effectiveness of two alternative strategies: (1) no HLA‐B*1502 gene allele screening and using carbamazepine and (2) HLA‐B*1502 gene allele screening and starting levetiracetam in the case of a positive screen. Results For the lifetime horizon, HLA‐B*1502 gene screening was the cost‐effective choice compared to no gene screening, with an incremental cost‐effectiveness ratio of $27 058 per quality‐adjusted life‐year (QALY), below the $50 000/QALY threshold in 99.69% of probabilistic sensitivity analyses. Although gene screening strategy was more expensive than a no screening strategy, it was more effective, yielding more QALYs, across all Asian ethnic groups. Significance Our analysis confirms the 2007 US Food and Drug Administration recommendation to screen for HLA‐B*1502 allele before starting treatment with carbamazepine in patients of Asian ancestry in the United States.