Page 164 - Genomic Medicine in Emerging Economies

Examples of Economic Evaluation and Cost-Effectiveness Analysis 153

Allopurinol
In the Thai population, the cost-utility analysis of HLA-B*5801 testing before
the allopurinol administration was performed using a societal perspective
(Saokaew et al., 2014). The model compared the cost-utility of a hypothetical
pharmacogenetics treatment arm to conventional treatment. The carriers of the
HLA-B*5801 allele received the alternative drug (probenecid), whereas all the
others received allopurinol. All probability data were derived from the litera-
ture (Somkrua et al., 2011) or calculated from conditional probabilities. Cost-
effectiveness was sensitive to the medical care cost of gout management, the
incidence of allopurinol-induced SJS/TEN, the probability of death with SJS/
TEN, and the cost of genetic testing. The authors suggested that the implemen-
tation of genotypic testing for the HLA-B*5801 allele might be potentially cost-
effective only in countries with a large number of subjects at risk, such as those
from the Southeast Asian and Han Chinese countries or those with a high prev-
alence of the HLA-B*5801 allele. HLA-B*5801 allele prevalence was reported as
high as 5.5–15% in the Thai and Han Chinese populations, whereas it was as
low as 0.6% and 0.8% in the Japanese and European populations. The findings
of a Korean study performed on a hypothetical cohort of gout patients with
chronic renal insufficiency were similar (Park et al., 2015). This study took a
national health payer’s perspective and concluded that allopurinol treatment
based on HLA-B*5801 genotyping could be more cost-effective, resulting in a
better outcome than the conventional treatment strategy.

Human Papillomavirus Testing
In South Africa a model was developed to determine the cost-effectiveness of
several cervical cancer screening strategies via human papillomavirus (HPV)
testing (Vijayaraghavan et al., 2009). Screening strategies included conven-
tional cytology, cytology followed by HPV testing for triage of equivocal cytol-
ogy, HPV testing, HPV testing followed by cytology for triage of HPV-positive
women, and coscreening with cytology. Primary outcome measures included
QALY saved, ICERs, and lifetime risk of cervical cancer. Results showed that
screening once every 10 years reduced the lifetime risk of cervical cancer by
13%–52%, depending on the screening strategy used. When strategies were
compared incrementally, cytology with HPV triage was less expensive and
more effective than screening using cytology alone. HPV testing with the use
of cytology triage was a more effective strategy, with a cost of an additional
R42,121 (R represents the local currency) per QALY. HPV testing with colpos-
copy for HPV-positive women was the next most effective option. Simultane-
ous HPV testing and cytology coscreening was the most effective strategy and
had an incremental cost of 25,414 rand (local currency) per QALY. Conclu-
sively, HPV testing for cervical cancer screening was a cost-effective strategy
in South Africa.