在HIV临床实践中CYP2B6基因分型用于优化依非韦伦剂量的成本效益分析
Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice.
作者信息
Schackman Bruce R, Haas David W, Park Sanghee S, Li X Cynthia, Freedberg Kenneth A
机构信息
Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA.
Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN, USA.
出版信息
Pharmacogenomics. 2015 Dec;16(18):2007-18. doi: 10.2217/pgs.15.142. Epub 2015 Nov 26.
Abstract
AIMS
To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA.
METHODS
We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses.
RESULTS
Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more.
CONCLUSION
CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.
摘要
目的
评估细胞色素P450 2B6（CYP2B6）基因分型指导依法韦仑剂量用于美国初始HIV治疗的成本效益。
方法
我们使用预防艾滋病并发症成本效益（CEPAC）微观模拟模型，预测接受或不接受CYP2B6基因分型的基于依法韦仑的HIV治疗的质量调整预期寿命和终身成本（2014年美元）。我们假设进行基因分型时，60%的患者有资格接受较低剂量治疗。
结果
与基因分型指导剂量相比，目前不进行CYP2B6基因分型的治疗每获得一个质量调整生命年的增量成本效益比>100,000美元，即使较低剂量会降低疗效。当我们假设可获得依法韦仑仿制药时，除非较低剂量使疗效降低6%或更多，结论相似。
结论
CYP2B6基因分型可为依法韦仑剂量提供依据并降低HIV治疗成本。
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