Research Article

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

Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA

Department of Internal Medicine, Respiratory, Allergy & Clinical Immunology Unit, Vinmec Healthcare System, Hanoi, Vietnam

College of Health Sciences, Vin University, Hanoi, Vietnam

Department of Medicine, Penn State University, Hershey, PA 17033, USA

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Nathorn Chaiyakunapruk

https://orcid.org/0000-0003-4572-8794

Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA

IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA

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Richard E Nelson

https://orcid.org/0000-0002-4441-7460

IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA

Division of Epidemiology, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA

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Daniel C Malone

*Author for correspondence:

E-mail Address: dan.malone@utah.edu

https://orcid.org/0000-0002-5006-9394

Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA

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Published Online:14 Sep 2023https://doi.org/10.2217/pgs-2023-0095

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Abstract

Background:HLA-B*58:01 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. Methods: A model was developed to compare three strategies: no screening, use allopurinol; HLA-B*58:01 screening; and no screening, use probenecid. A willingness-to-pay of three-times gross domestic product per capita was used. Results: 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. Conclusion: The implementation of nationwide HLAB*58:01 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.

Keywords:

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Vol. 24, No. 13

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Received 28 May 2023

Accepted 18 August 2023

Published online 14 September 2023

Published in print August 2023

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/pgs-2023-0095

Author contributions

All authors contributed to the design of the study. KNC Duong participated in developing the research design, analyzed data, interpreted the results and drafted the manuscript. DV Nguyen provided clinical expert's opinions and experience in the local context and feedback on competing strategies in the model, provided interpretation and critically reviewed the manuscript. N Chaiyakunapruk contributed to the research method, provided interpretation and critically reviewed and edited the manuscript. RE Nelson contributed to the research method, provided interpretation and critically reviewed and edited the manuscript. DC Malone supervised the study, guided the analysis, provided interpretation and reviewed and edited the manuscript. KNC Duong, DV Nguyen, N Chaiyakunapruk, RE Nelson and DC Malone did final approval of the manuscript to be published. All authors were responsible for the agreement to be accountable for all aspects of the work.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This article does not contain any studies involving human participants performed by any of the authors.

Data sharing statement

The data that support the findings of this study are available from the corresponding author (DC Malone), upon reasonable request.

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Cost–effectiveness of HLA-B*58:01 testing to prevent Stevens–Johnson syndrome/toxic epidermal necrolysis in Vietnam

Abstract

References

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