Choong Chiau Ling, Islahudin Farida, Makmor-Bakry Mohd, Mohd Tahir Nor Asyikin, Wong Hin-Seng, Yahya Rosnawati
Centre of Quality Medicine Management, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.
Department of Nephrology, Sunway Medical Centre, Petaling Jaya , MYS.
Cureus. 2024 Sep 11;16(9):e69221. doi: 10.7759/cureus.69221. eCollection 2024 Sep.
Introduction Genetic variations can influence how kidney transplant recipients (KTRs) respond to immunosuppressive drugs. However, limited resources necessitate a cost-benefit analysis of pharmacogenetic testing to determine its role in routine practice. This study investigated the cost-effectiveness of three genetic polymorphisms (, , and) in KTRs. Methods This was a multicenter, prospective observational cohort study that included patients on tacrolimus-mycophenolate-prednisolone treatment. Ethnically diverse adult KTRs who had undergone kidney transplantation between 2020 and 2021 and consented were enrolled in the study. Deoxyribonucleic acid (DNA) was extracted from the collected blood samples using a commercially available kit. , , and single nucleotide polymorphisms (SNPs) were determined by polymerase chain reaction (PCR). Results Data was analyzed from 39 KTRs with an average age of 32.2 ± 7.0 years. The median annual healthcare cost per patient was MYR 52,700 (laboratory tests and immunosuppressants being the highest expenses). Notably, the annual cost was significantly higher in patients with the variant compared to the wildtype (p < 0.001). Furthermore, an incremental cost-effectiveness analysis revealed that carriers of the wildtype allele, the variant allele, and the variant allele were associated with a more cost-effective approach to kidney transplantation management, potentially reducing the risk of graft rejection and acute tubular necrosis (ATN). Conclusion While these findings suggest potential cost benefits for specific genotypes, further research with larger and more diverse patient populations is necessary to definitively establish the role of pharmacogenetic testing in optimizing cost-effectiveness for KTRs.
引言 基因变异会影响肾移植受者（KTRs）对免疫抑制药物的反应。然而，资源有限使得有必要对药物遗传学检测进行成本效益分析，以确定其在常规实践中的作用。本研究调查了KTRs中三种基因多态性（ 、 和 ）的成本效益。方法 这是一项多中心、前瞻性观察队列研究，纳入接受他克莫司-霉酚酸酯-泼尼松龙治疗的患者。2020年至2021年间接受肾移植并同意参与的不同种族成年KTRs被纳入研究。使用市售试剂盒从采集的血样中提取脱氧核糖核酸（DNA）。通过聚合酶链反应（PCR）测定 、 和 单核苷酸多态性（SNP）。结果 对39名平均年龄为32.2±7.0岁的KTRs进行了数据分析。每位患者的年度医疗保健费用中位数为52,700马来西亚林吉特（实验室检查和免疫抑制剂费用最高）。值得注意的是，与野生型相比，具有 变异的患者年度费用显著更高（p < 0.001）。此外，增量成本效益分析表明， 野生型等位基因、 变异等位基因和 变异等位基因的携带者在肾移植管理方面采用的方法更具成本效益，可能降低移植排斥和急性肾小管坏死（ATN）的风险。结论 虽然这些发现表明特定基因型可能具有成本效益，但需要对更大、更多样化的患者群体进行进一步研究，以明确确定药物遗传学检测在优化KTRs成本效益方面的作用。
