An Updated Economic Evaluation of HLA-B*58:01 Genotype Testing in Gouty Patients for Preventing Severe Allopurinol Hypersensitivity in Thailand
1
Issued Date
2025-08-01
Resource Type
eISSN
25785745
Scopus ID
2-s2.0-105013791211
Journal Title
Acr Open Rheumatology
Volume
7
Issue
8
Rights Holder(s)
SCOPUS
Bibliographic Citation
Acr Open Rheumatology Vol.7 No.8 (2025)
Suggested Citation
Dilokthornsakul P., Louthrenoo W., Yadee J., Siripaitoon B., Jatuworapruk K., Vannaprasaht S., Rerkpattanapipat T., Chungcharoenpanich A., Iamsumang W., Upakdee N., Dechanont S., Lawanaskol S., Butthum B., Chevaisrakul P., Towiwat P. An Updated Economic Evaluation of HLA-B*58:01 Genotype Testing in Gouty Patients for Preventing Severe Allopurinol Hypersensitivity in Thailand. Acr Open Rheumatology Vol.7 No.8 (2025). doi:10.1002/acr2.70093 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111847
Title
An Updated Economic Evaluation of HLA-B*58:01 Genotype Testing in Gouty Patients for Preventing Severe Allopurinol Hypersensitivity in Thailand
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: Human Leukocyte Antigen (HLA), specifically HLA-B*58:01, testing before allopurinol initiation in patients with gout in Thailand was previously shown to be cost-effective. However, several drugs are available in the treatment of gout in Thailand, so the updated cost-effectiveness analysis is warranted. This study aimed to update the cost-effectiveness of HLA-B*58:01 testing before allopurinol initiation in patients with gout in Thailand. Methods: A hybrid model consisting of a decision tree and a Markov model with a lifetime horizon from a societal perspective was undertaken. The HLA-B*58:01 testing was compared to the standard of care as no testing. Total health care costs and quality-adjusted life years (QALYs) were assessed. A comprehensive literature review along with retrospective data analysis and prospective data collection were conducted to determine inputs to inform the model. The incremental cost-effectiveness ratio analysis was calculated. Results: HLA-B*58:01 testing could avoid 1.554 Stevens-Johnson syndrome and toxic epidermal necrosis cases, resulting in a saving of 0.140 patients’ lives per 1,000 patients. It could gain 0.002 life-years and 0.004 QALYs compared to no testing. However, it required a higher lifetime cost of 4,690 Thai baht (THB), resulting in an incremental cost-effectiveness ratio of 1,093,068 THB/QALY (31,404 US dollars per QALY). Conclusion: HLA-B*58:01 testing was not cost-effective before allopurinol initiation in Thai patients with gout at the current price of 1,000 THB per test. However, HLA-B*58:01 testing would be cost-effective if only probenecid was the alternative treatment for patients with positive HLA-B*58:01 results. This result would be useful for health authorities, policy decision-makers, and physicians’ organizations in providing the recommendation for HLA-B*58:01 testing before initiation of allopurinol.