Cost-Effectiveness Analysis of HLA-B5801 Genotyping in the Treatment of Gout Patients with Chronic Renal Insufficiency in Korea

Dong-Jin Park¹, Kyung-Eun Lee¹, Sung-Hwan Park² and Shin-Seok Lee³, ¹Rheumatology, Chonnam National University Medical School, Gwangju, South Korea, ²Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea, ³Dept of Int Med/Rheumatology, Chonnam National University Medical School, Gwangju, South Korea

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: gout

Session Information

Title: Metabolic and Crystal Arthropathies: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose

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 guideline recommends 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 treatment of gout in patients with chronic renal insufficiency in Korea.

Methods

A decision analytic 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 SCAR patients from two 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 with the conventional and HLA-B5801 screening strategies were US $1,193 and US $1,055, and 97.8% and 100%, respectively. The result was 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.

Disclosure:

D. J. Park,
None;

K. E. Lee,
None;

S. H. Park,
None;

S. S. Lee,
None.

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