Cost-effectiveness of HLA-B58:01 testing to prevent Stevens-Johnson syndrome/toxic epidermal necrolysis in Vietnam

• Published in: Pharmacogenomics 2023-08, Vol.24 (13), p.713-724
• Main Authors: Duong, Khanh Nc, Nguyen, Dinh Van, Chaiyakunapruk, Nathorn, Nelson, Richard E, Malone, Daniel C
• Format: Article
• Language: English
• Subjects: Allopurinol - adverse effects; Allopurinol - economics; Cost-Benefit Analysis - methods; HLA-B Antigens - genetics; Humans; Probenecid - adverse effects; Probenecid - economics; Quality-Adjusted Life Years; Stevens-Johnson Syndrome - economics; Stevens-Johnson Syndrome - genetics; Stevens-Johnson Syndrome - prevention & control; Vietnam
• ISSN: 1462-2416; 1744-8042; 1744-8042
• DOI: 10.2217/pgs-2023-0095

is strongly associated with allopurinol-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in Vietnam. This study assessed the cost-effectiveness of this testing to prevent SJS/TEN. A model was developed to compare three strategies: no screening, use allopurinol; screening; and no screening, use probenecid. A willingness-to-pay of three-times gross domestic product per capita was used. Compared with 'no screening, use allopurinol', 'screening' increased quality-adjusted life-years by 0.0069 with the incremental cost of Vietnam dong (VND) 14,283,633 (US$617), yielding an incremental cost-effectiveness ratio of VND 2,070,459,122 (US$89,398) per quality-adjusted life-year. Therefore, 'screening' was unlikely to be cost-effective under the current willingness-to-pay. Testing's cost-effectiveness may change with targeted high-risk patients, reimbursed febuxostat or lower probenecid prices. The implementation of nationwide testing before the use of allopurinol is not cost-effective, according to this analysis. This may be due to the lack of quality data on the effectiveness of testing and costing data in the Vietnamese population.