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Cost-effectiveness analysis of genotyping for HLA-B*15:02 in Indonesian patients with epilepsy using a generic model

The Pharmacogenomics Journal volume 21, pages 476–483 (2021)Cite this article

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Abstract

Carbamazepine (CBZ)-induced Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are strongly associated with the HLA-B*15:02 allele. Screening HLA-B*15:02 before CBZ administration might prevent CBZ-induced SJS/TEN by enabling clinicians to prescribe alternative therapy for positive patients. Similar to other Southeastern Asian countries, HLA-B*15:02 is highly prevalent in Indonesia. Therefore, we assessed the economic value of HLA-B*15:02 screening before CBZ prescription to patients with epilepsy in Indonesia. A generic cost-effectiveness model and decision support tool, developed to enable users to perform an initial cost-effectiveness analysis from a healthcare provider/payer perspective, were used to assess the value of HLA-B*15:02 genotyping. The incremental cost-effectiveness ratio of adopting universal HLA-B*15:02 screening was 656,444,671 Indonesian Rupiah (IDR)/quality-adjusted life year (QALY) gained for patients compared with 2,634,975,574 IDR/QALY gained for providing valproic acid (alternative drug) without screening. Thus, neither HLA-B*15:02 screening nor substitution with VPA meets the Indonesian threshold for cost effectiveness. However, the improved outcomes with this test in other Asian countries may inform the desirability of implementation in Indonesia even with suboptimal cost-effectiveness.

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Fig. 1: Decision tree model showing the three potential strategies for the treatment of patients with epilepsy [27].
Fig. 2: Markov model showing the three potential outcomes for patients treated with CBZ or VPA [27].
Fig. 3: Cost-effectiveness acceptability curves: the likelihood that each strategy will be acceptable to a decision maker, ultimately influencing their willingness to pay.

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Acknowledgements

This project was funded by a grant from the U.S. National Institutes of Health/National Human Genome Research Institute (no. U01HG007269) and Directorate of Higher Education, Ministry of Research, Technology and Higher Education of the Republic of Indonesia by World Class Professor Program (no 123.56/D2.3/KP/2018). We thank the YARSI collaborative hospitals and participants for their contribution to this study. We also thank to Dr. Rizaldy T Pinzon, Dr. Syukrini Bahri, Dr. Isa M Noor, and Ms. Ratih Puspita, who supported in sample and data collection.

Author information

Authors and Affiliations

  1. Department of Pharmacology, Faculty of Medicine, YARSI University, Jakarta Pusat, Indonesia

    Rika Yuliwulandari

  2. Genetic Research Center, YARSI Research Institute, YARSI University, Jakarta Pusat, Indonesia

    Rika Yuliwulandari & Kinasih Prayuni

  3. Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea

    Jae Gook Shin

  4. Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea

    Jae Gook Shin

  5. Department of Pharmacology and Therapy, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

    Erna Kristin & Iwan Dwi Prahasto

  6. Department of Pharmacology & Therapeutic, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia

    Fransiscus D. Suyatna

  7. Medical Genetics Section, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand

    Surakameth Mahasirimongkol

  8. Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, USA

    Larisa H. Cavallari

  9. The Golden Helix Foundation, London, UK

    Christina Mitropoulou

  10. Department of Pharmacy, University of Patras, Patras, Greece

    George P. Patrinos

  11. Department of Pathology, United Arab Emirates University College of Medicine and Health Sciences, Al-Ain, UAE

    George P. Patrinos

  12. Department of Population Health Sciences, Geisinger, Danville, PA, USA

    Jing Hao

  13. Genomic Medicine Institute, Geisinger, Danville, PA, USA

    Marc S. Williams

  14. Health Policy & Behavioral Sciences, Georgia State University, Atlanta, GA, USA

    Susan R. Snyder

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  1. Rika Yuliwulandari
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Correspondence to Rika Yuliwulandari.

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Yuliwulandari, R., Shin, J.G., Kristin, E. et al. Cost-effectiveness analysis of genotyping for HLA-B*15:02 in Indonesian patients with epilepsy using a generic model. Pharmacogenomics J 21, 476–483 (2021). https://doi.org/10.1038/s41397-021-00225-9

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