Reducing hypersensitivity reactions with HLA-B*5701 genotyping before abacavir prescription

Kapoor, Ritika; Martinez-Vega, Rosario; Dong, Di; Tan, Sharlene Yanying; Leo, Yee‐Sin; Lee, Cheng-Chuan; Sung, Cynthia; Ng, Oon-Tek; Archuleta, Sophia; Teo, Yik-Ying

doi:10.1097/fpc.0000000000000107

Cited by 32 publications

(28 citation statements)

References 18 publications

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“…The majority of studies fulfilled the criteria of QHES items 8 and 9. Only four studies did not choose the appropriate time horizon or did not discount benefits and costs beyond 1 year (QHES item 8) [ 43 , 46 , 51 , 55 ]. Furthermore, four studies failed to measure the costs appropriately or to describe methods for estimations of quantities and unit costs clearly (QHES item 9) [ 41 , 46 , 47 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany

et al. 2016

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BackgroundThe use of targeted therapies has recently increased. Pharmacogenetic tests are a useful tool to guide patient treatment and to test a response before administering medicines. Pharmacogenetic tests can predict potential drug resistance and may be used for determining genotype-based drug dosage. However, their cost-effectiveness as a diagnostic tool is often debatable. In Germany, 47 active ingredients are currently approved. A prior predictive test is required for 39 of these and is recommended for eight. The objective of this study was to review the cost-effectiveness (CE) of pharmacogenetic test-guided drug therapy and compare the application of drugs with and without prior genetic testing.MethodsA systematic literature review was conducted to identify the CE and cost-utility of genetic tests. Studies from January 2000 until November 2015 were searched in 16 databases including Medline, Embase, and Cochrane. A quality assessment of the full-text publications was performed using the validated Quality of Health Economic Studies (QHES) instrument.ResultsIn the majority of the included studies, the pharmacogenetic test-guided therapy represents a cost-effective/cost-saving treatment option. Only seven studies lacked a clear statement of CE or cost-savings, because of uncertainty, restriction to specific patient populations, or assumptions for comparative therapy. Moreover, the high quality of the available evidence was evaluated.ConclusionPharmacogenetic testing constitutes an opportunity to improve the CE of pharmacotherapy. The CE of targeted therapies depends on various factors including costs, prevalence of biomarkers, and test sensitivity and specificity. To guarantee the CE comparability of stratified drug therapies, national and international standards for evaluation studies should be defined.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0376-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany

et al. 2016

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“…Recently, the cost-effectiveness of HLA-B * 57: 01 genotyping related to prescribing abacavir has been questioned, in particular in regions and populations with low prevalence [34,35] . The cost-effectiveness of pharmacogenomic screening is influenced by many factors, with allele frequency and availability of laboratory tests being some of them.…”

Section: Discussionmentioning

confidence: 99%

High Frequency of Human Leukocyte Antigen-B*57:01 Allele Carriers among HIV-Infected Patients in Serbia

Šiljić

Salemović²,

Ćirković³

et al. 2017

Intervirology

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Abacavir is an effective antiretroviral drug and one of the most commonly used nucleoside reverse transcriptase inhibitors in Serbia. А percentage of the treated patients experience a potentially life-threatening hypersensitivity reaction, which was shown to be associated with the presence of the class I MHC allele, HLA-B*57:01; hence genotyping for HLA-B*57:01 prior to starting abacavir is nowadays recommended in international HIV treatment guidelines. In Serbia, this testing became available in 2013. This study was designed to estimate the prevalence of the HLA-B*57:01 allele in Serbian HIV-1-infected patients. The presence of the HLA-B*57:01 allele was analyzed in 273 HIV-1-infected patients aged 18 years or more, who were abacavir naïve. Buccal swab samples were obtained from all participants and assayed for the presence of HLA-B*57:01 using a commercially available HLA-B*57:01 real-time PCR kit. The presence of the HLA-B*57:01 allele was found in 22 of 273 tested individuals (8%; 95% CI 5.4-11.9%). This is the first study that estimated the HLA-B*57:01 prevalence among HIV-infected patients in Serbia. The very high prevalence of HLA-B*57:01 found in our study strongly supports HLA-B*57:01 genotyping, which should be implemented prior to the initiation of an abacavir-containing therapy to reduce the risk of potentially life-threatening hypersensitivity reactions.

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“…This was exactly the case for HLA-B*15:02 screening before carbamazepine prescription in East Asians, [33][34][35] delivering overall savings to the health-care system despite having to screen a greater number of patients to deliver the benefit to one patient. However, it should be reminded that the findings of cost savings are context-specific and not directly transferable across different health systems, such as the discovery of HLA-B*57:01 testing being not cost-effective for East and Southeast Asian populations, 36,37 despite being ascertained to be so in European populations. [38][39][40] Disparities in local allele prevalence and health-care cost structure can produce opposing conclusions to the economic modelling.…”

Section: Swot Analysis Of Pharmacogenetics In Health Carementioning

confidence: 99%

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis

2016

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Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

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Reducing hypersensitivity reactions with HLA-B*5701 genotyping before abacavir prescription

Cited by 32 publications

References 18 publications

Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany

Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany

High Frequency of Human Leukocyte Antigen-B*57:01 Allele Carriers among HIV-Infected Patients in Serbia

Role of pharmacogenetics in public health and clinical health care: a SWOT analysis

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