Department of Pharmacy, Wuxi Children's Hospital.
Department of Pharmacy, Wuxi 9th People's Hospital affiliated to Soochow University and Wuxi Orthopaedic Hospital, Wuxi, Jiangsu.
Pharmacogenet Genomics. 2023 Feb 1;33(2):24-34. doi: 10.1097/FPC.0000000000000488. Epub 2022 Dec 9.
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.
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.
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.
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.
从医疗保健系统的角度出发，评估中国广泛的人类白细胞抗原 B（HLA-B）*58：01 基因分型指导降尿酸治疗或非布司他起始治疗对伴有轻度至中度慢性肾脏病（CKD）的痛风患者的长期经济影响。
采用决策树嵌入的Markov模型，包括四个相互排斥的健康状态（治疗未控制、治疗控制、治疗未控制且停药、死亡）。主要基于中国真实世界数据，从三组（普遍 HLA-B*58：01 检测策略、在开始使用别嘌醇或非布司他之前不进行基因分型）评估 25 年时间内每获得一个质量调整生命年（QALY）的增量成本。所有成本均根据中国消费者价格指数调整为 2021 年水平，并按 5%的年贴现率贴现。进行了单因素敏感性分析和概率敏感性分析。
在这三组中，根据中国平均意愿支付阈值$37654.50/QALY，普遍 HLA-B*58：01 基因分型是最具成本效益的策略。基于增量成本-效果比为$31784.55/QALY，与不进行基因分型相比，在 25 年时间内，每个患者额外增加 0.046 个 QALY，增加 1463.81 美元的增量成本。敏感性分析显示，这些结果的稳健性为 64.3%。
从中国医疗保健系统的角度来看，对于中国大陆轻度至中度 CKD 的痛风患者，HLA-B*58：01 基因分型策略具有成本效益，特别是在经济最发达的地区，如北京和上海。因此，我们建议中国卫生当局选择基因分型策略，并根据当地条件的差异做出不同的建议。
