Abstract
Background: Based on the prioritization and selection of pharmacogenomic testing (gene-drug pairs) that should be considered to perform economic evaluation, it was found that the economic evaluation of HLA-B*57:01 genetic testing compared to no genetic testing before starting treatment with abacavir to prevent Hypersensitivity Reaction (HSR) in HIV-infected patients should be conducted. Objectives: The objective of this study was to evaluate the economic evaluation of HLA-B*57:01 genetic testing compared to no genetic testing before starting treatment with abacavir to prevent HSR in HIV-infected patients and to assess the budget impact of HLA-B*57:01 genetic testing if we included in the benefits package of the Universal Health Coverage (UHC). Methods: Economic evaluation of HLA-B*57:01 gene testing compared to no genetic testing before starting treatment with abacavir as first-line or second-line treatment was conducted using a cost-utility analysis method using a decision tree and Markov model based on societal and governmental perspectives. Data on probability, cost, and utility were obtained from literature reviews. The results were presented as an incremental cost-effectiveness ratio (ICER) and parameter uncertainty was assessed using one-way sensitivity and probabilistic sensitivity analyses. In addition, the budget impact analysis was calculated using the governmental perspective. Results: Compared to no genetic testing, the ICER value of HLA-B*57:01 genetic testing before starting first-line treatment with abacavir (scenario 1) was equal to 4,075 in a societal perspective and cost-saving (-6,412 baht per quality adjusted life year (QALY) gained) based on a governmental perspective. In addition, the ICER value of HLA-B*57:01 genetic testing compared with no gene testing before starting second-line abacavir treatment (scenario 2) was equal to 18,437 (societal perspective) and 1,793 baht per QALY gained (governmental perspective). It also resulted in a budget impact of HLA*B-57:01 genetic testing compared to no testing, equal to 4,230,000 baht per year in scenario 2. Conclusions: When considering the willingness to pay threshold for Thailand at 160,000 baht per QALY gained, HLA-B*57:01 genetic testing for the HIV infected patients before starting abacavir regimen as first-line or second-line treatment would be cost-effective. Therefore, our findings supported policy decision making on the inclusion of HLA-B*57:01 genetic testing into the benefit package of UHC for the HIV infected patients before starting abacavir regimen as first-line or second-line treatment.
