The cost-effectiveness of HLA-B*5701 genetic screening to guide initial antiretroviral therapy for HIV

AIDS. 2008 Oct 1;22(15):2025-33. doi: 10.1097/QAD.0b013e3283103ce6.

Abstract

Objective: To evaluate the clinical impact and cost-effectiveness of HLA-B*5701 testing to guide selection of first-line HIV regimens in the United States.

Design: Cost-effectiveness analysis using a simulation model of HIV disease. The prevalence of HLA-B*5701 and the probabilities of confirmed and unconfirmed severe systemic hypersensitivity reaction among patients taking abacavir testing HLA-B*5701 positive and negative were from the Prospective Randomized Evaluation of DNA Screening in a Clinical Trial study. The monthly costs of abacavir-based and tenofovir-based regimens were $1135 and $1139, respectively; similar virologic efficacy was assumed and this assumption was varied in sensitivity analysis.

Patients: Simulated cohort of patients initiating HIV therapy.

Interventions: The interventions are first-line abacavir, lamivudine, and efavirenz without pretreatment HLA-B*5701 testing; the same regimen with HLA-B*5701 testing; and first-line tenofovir, emtricitabine, and efavirenz.

Main outcome measures: Quality-adjusted life years and lifetime medical costs discounted at 3% per annum, cost-effectiveness ratios ($/QALY).

Results: Abacavir-based treatment without HLA-B*5701 testing resulted in a projected 30.93 years life expectancy, 16.23 discounted quality-adjusted life years, and $472,200 discounted lifetime cost per person. HLA-B*5701 testing added 0.04 quality-adjusted months at an incremental cost of $110, resulting in a cost-effectiveness ratio of $36,700/QALY compared with no testing. Initiating treatment with a tenofovir-based regimen increased costs without improving quality-adjusted life expectancy. HLA-B*5701 testing remained the preferred strategy only if abacavir-based treatment had equal efficacy and cost less per month than tenofovir-based treatment. Results were also sensitive to the cost of HLA-B*5701 testing and the prevalence of HLA-B*5701.

Conclusion: Pharmacogenetic testing for HLA-B*5701 is cost-effective only if abacavir-based treatment is as effective and costs less than tenofovir-based treatment.

Publication types

  • Evaluation Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenine / analogs & derivatives
  • Adenine / economics
  • Adenine / therapeutic use
  • Adult
  • Anti-HIV Agents / adverse effects
  • Anti-HIV Agents / economics
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / economics
  • Cost-Benefit Analysis
  • Dideoxynucleosides / adverse effects
  • Dideoxynucleosides / economics
  • Dideoxynucleosides / therapeutic use
  • Drug Costs / statistics & numerical data
  • Drug Hypersensitivity / economics
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / genetics
  • Drug Hypersensitivity / prevention & control
  • Female
  • Genetic Testing / economics*
  • Genetic Testing / methods
  • HIV Infections / drug therapy*
  • HIV Infections / economics
  • HIV Infections / genetics*
  • HLA-B Antigens / genetics*
  • Health Care Costs / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Models, Biological
  • Organophosphonates / economics
  • Organophosphonates / therapeutic use
  • Pharmacogenetics / economics
  • Quality-Adjusted Life Years
  • Reverse Transcriptase Inhibitors / adverse effects
  • Sensitivity and Specificity
  • Tenofovir
  • Treatment Outcome

Substances

  • Anti-HIV Agents
  • Dideoxynucleosides
  • HLA-B Antigens
  • HLA-B*57:01 antigen
  • Organophosphonates
  • Reverse Transcriptase Inhibitors
  • Tenofovir
  • Adenine
  • abacavir