Department of Neurology, Faculty of Medicine, University of Sam Ratulangi/RD Kandou Hospital, Manado, Indonesia.
Department of Neurology, Faculty of Medicine, University of Sam Ratulangi/RD Kandou Hospital, Manado, Indonesia.
Epilepsy Behav. 2024 Jun;155:109787. doi: 10.1016/j.yebeh.2024.109787. Epub 2024 Apr 23.
Adverse skin reactions due to drugs such as Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) occur in 3% of people receiving anti epileptic drugs (AED). Although SJS/TEN has a low incidence, the mortality and morbidity rates are high. Indonesia has not adopted HLA-B1502 screening prior to administration of carbamazepine (CBZ), although previous studies found a relationship between HLA-B1502 and SJS/TEN.
A hybrid decision tree and Markov model was developed to evaluate three strategies for treating newly diagnosed focal epilepsy: CBZ direct therapy, levetiracetam (LEV) direct therapy, and therapy based on HLA-B*15:02 test results. From a societal perspective, base case and sensitivity analyses were carried out over a lifetime.
Direct administration of CBZ appears to have a slightly lower average cost than the HLA-B15:02 allele screening strategy. The increase in quality-adjusted life year (QALY) in HLA-B15:02 screening before treatment related to the cost difference reached 0.519 with an incremental cost-effectiveness ratio (ICER) of around USD 984 per unit of QALY acquisition. Direct treatment of LEV increased treatment costs by almost USD 2000 on average compared to the standard CBZ strategy. The increase in QALY is 0.834 in direct levetiracetam treatment, with an ICER of around USD 2230 for each QALY processing.
Calculation of the cost-effectiveness of lifetime epilepsy therapy in this study found that the initial screening strategy with the HLA-B*15:02 test was the most cost-effective.
接受抗癫痫药物（AED）治疗的人群中，有 3%会出现史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）等药物引起的皮肤不良反应。虽然 SJS/TEN 的发病率较低，但死亡率和发病率都很高。印度尼西亚在给予卡马西平（CBZ）之前并未采用 HLA-B1502 筛查，尽管之前的研究发现 HLA-B1502 与 SJS/TEN 之间存在关联。
开发了混合决策树和马尔可夫模型，以评估三种治疗新发局灶性癫痫的策略：CBZ 直接治疗、左乙拉西坦（LEV）直接治疗和基于 HLA-B*15:02 测试结果的治疗。从社会角度出发，对终生进行了基础案例和敏感性分析。
CBZ 的直接给药似乎比 HLA-B15:02 等位基因筛查策略具有略低的平均成本。治疗相关 HLA-B15:02 筛查前的质量调整生命年（QALY）增加与成本差异相关，达到 0.519，增量成本效益比（ICER）约为每单位 QALY 获得 984 美元。与标准 CBZ 策略相比，LEV 的直接治疗平均增加了近 2000 美元的治疗成本。直接使用左乙拉西坦治疗的 QALY 增加了 0.834，每个 QALY 处理的 ICER 约为 2230 美元。
本研究对终生癫痫治疗的成本效益进行了计算，发现初始 HLA-B*15:02 测试筛查策略最具成本效益。
