A lifetime economic research of universal HLA-B*58:01 genotyping or febuxostat initiation therapy in Chinese gout patients with mild to moderate chronic kidney disease.

IF 1.7 3区 医学 Q4 BIOTECHNOLOGY & APPLIED MICROBIOLOGY
Yuan Hong, Xichuang Chen, Zhiping Li, Xiaoyan Zhang, Cong Zhou, Yan Wang, Guangfei Wang, Wei Wu, Danli Zhou, Hai Feng Li
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引用次数: 0

Abstract

Objective: To evaluate Chinese long-term economic impact of universal human leukocyte antigen B (HLA-B)*58:01 genotyping-guided urate-lowering therapy or febuxostat initiation therapy for gout patients with mild to moderate chronic kidney disease (CKD) from perspective of healthcare system.

Methods: A Markov model embedded in a decision tree was structured including four mutually exclusive health states (uncontrolled-on-therapy, controlled-on-therapy, uncontrolled-off-therapy, and death). Mainly based on Chinese real-world data, the incremental costs per quality-adjusted life years (QALYs) gained were evaluated from three groups (universal HLA-B*58:01 testing strategy, and no genotyping prior to allopurinol or febuxostat initiation therapy) at 25-year time horizon. All costs were adjusted to 2021 levels based on Chinese Consumer Price Index and were discounted by 5% annually. One-way and probability sensitivity analysis were performed.

Results: Among these three groups, universal HLA-B*58:01 genotyping was the most cost-effective strategy in base-case analysis according to Chinese average willingness-to-pay threshold of $37 654.50 per QALY. The based incremental cost-effectiveness ratio was $31784.55 per QALY, associated with 0.046 additional QALYs and $1463.81 increment costs per patient at a 25-year time horizon compared with no genotyping prior to allopurinol initiation strategy. Sensitivity analysis showed 64.3% robustness of these results.

Conclusion: From Chinese perspective of healthcare system, HLA-B*58:01 genotyping strategy was cost-effective for gout patients with mild to moderate CKD in mainland China, especially in the most developed area, such as Beijing and Shanghai. Therefore, we suggest China's health authorities choose the genotyping strategy and make different recommendations according to the differences of local conditions.

中国痛风合并轻中度慢性肾病患者HLA-B*58:01基因分型或非布司他起始治疗的终生经济研究
目的:从卫生保健系统角度评价通用人白细胞抗原B (HLA-B)*58:01基因分型引导的降尿酸治疗或非布司他起始治疗对痛风合并轻中度慢性肾病(CKD)患者的长期经济影响。方法:构建一个嵌入决策树的马尔可夫模型,包括四种互斥的健康状态(不受控制的治疗、不受控制的治疗、不受控制的治疗和死亡)。主要基于中国真实世界数据,从三组(通用HLA-B*58:01检测策略,在别嘌呤醇或非布司他起始治疗前未进行基因分型)中评估25年时间范围内获得的每个质量调整生命年(QALYs)的增量成本。所有成本均根据中国消费者价格指数调整至2021年水平,并按5%折现。进行单因素分析和概率敏感性分析。结果:根据中国人平均支付意愿阈值为37654.50美元/ QALY,在这三组中,通用HLA-B*58:01基因分型是基本病例分析中最具成本效益的策略。基于增量成本-效果比为每个QALY 31784.55美元,与在别嘌呤醇起始策略之前没有基因分型的患者相比,在25年的时间范围内,每位患者额外的QALY为0.046美元,增量成本为1463.81美元。敏感性分析结果稳健性为64.3%。结论:从中国医疗体系的角度来看,HLA-B*58:01基因分型策略在中国大陆地区,特别是在北京、上海等发达地区,对轻中度CKD痛风患者具有成本效益。因此,我们建议中国卫生部门选择基因分型策略,并根据当地情况的差异提出不同的建议。
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来源期刊
Pharmacogenetics and genomics
Pharmacogenetics and genomics 医学-生物工程与应用微生物
CiteScore
3.20
自引率
3.80%
发文量
47
审稿时长
3 months
期刊介绍: ​​​​Pharmacogenetics and Genomics is devoted to the rapid publication of research papers, brief review articles and short communications on genetic determinants in response to drugs and other chemicals in humans and animals. The Journal brings together papers from the entire spectrum of biomedical research and science, including biochemistry, bioinformatics, clinical pharmacology, clinical pharmacy, epidemiology, genetics, genomics, molecular biology, pharmacology, pharmaceutical sciences, and toxicology. Under a single cover, the Journal provides a forum for all aspects of the genetics and genomics of host response to exogenous chemicals: from the gene to the clinic.
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