| DOI: 10.29090/psa.2025.03.24.3486 | Pharm Sci Asia 2025; 52(3), 302-311 |
Economic evaluation of HLA-B*13:01 screening for the prevention of phenobarbital-induced drug reaction with eosinophilia and systemic symptoms (DRESS) in Thai pediatric patientsSaowalak Turongkaravee1,*, Titinan Sanoa2, Nipathorn Poperm2, Jennis Meanwatthana2
1 Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
2
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Pharmacogenetic testing plays a critical role in identifying individuals at risk for adverse drug reactions (ADRs). A case-control study demonstrated significant association between HLA-B*13:01 gene and phenobarbital-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) in Thai pediatric epilepsy patients, with an odds ratio of 4.3 (95% CI: 1.28–14.26, p = 0.022). Notably, HLA-B*13:01 is the third most prevalent genetic marker associated with cutaneous ADRs in Thailand. However, there is currently no economic evaluation to guide decision-making for preventing severe ADRs. This study aims to perform a cost-utility analysis of HLA-B*13:01 screening prior to initiating phenobarbital treatment to prevent DRESS and alternative drug with sodium valproate, a lower DRESS risk but higher cost, compared to phenobarbital treatment without screening in pediatric epilepsy patients. Decision tree and Markov models were developed to evaluate lifetime costs and quality-adjusted life years (QALYs) from both payer and societal perspectives. Input data, including costs, utilities, and transition probabilities, were derived from relevant literature focused on Thai pediatric epilepsy patients. Sensitivity analyses were conducted. Implementing HLA-B*13:01 screening before initiating phenobarbital therapy and alternative treatment strategy was cost-saving compared to no-screening strategy, yielding higher QALYs and lower costs. Furthermore, the number needed to screen of 14 to prevent one DRESS case. One-way sensitivity analysis highlighted that the probability of death from DRESS was the most impacted on the ICER. At the Thai cost-effectiveness threshold of 160,000 THB/QALY, the alternative drug, sodium valproate demonstrated 94% probability of being cost-effective, indicating that it is the most cost-effective option.
Keyword:
Cost-utility analysis; Economic evaluation; HLA-B*13:01; Drug reaction with eosinophilia and systemic symptoms (DRESS); Phenobarbital-induced DRESS; Adverse drug reactions
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