Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany
<p>Abstract</p> <p>Objective</p> <p>Avoiding abacavir in HIV-infected patients tested positive for HLA-B*5701 reduces the risk of abacavir hypersensitivity reaction (ABC-HSR). Our aim was to assess the costs of clinically suspected HSR and to estimate potential cost sav...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2010-04-01
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| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | http://www.eurjmedres.com/content/15/4/145 |
| _version_ | 1830213992990113792 |
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| author | Wolf E Blankenburg M Bogner JR Becker W Gorriahn D Mueller MC Jaeger H Welte R Baudewig M Walli R Stoll M |
| author_facet | Wolf E Blankenburg M Bogner JR Becker W Gorriahn D Mueller MC Jaeger H Welte R Baudewig M Walli R Stoll M |
| author_sort | Wolf E |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Objective</p> <p>Avoiding abacavir in HIV-infected patients tested positive for HLA-B*5701 reduces the risk of abacavir hypersensitivity reaction (ABC-HSR). Our aim was to assess the costs of clinically suspected HSR and to estimate potential cost savings of implementing prospective HLA-B*5701-screening for HIV-infected patients initiating abacavir/lamivudine fixed-dose combination (ABC/3TC FDC) compared to initiating respective treatment without screening.</p> <p>Methods</p> <p>Employing a decision tree model the expected HSR-related costs of screening vs. no screening were estimated from the societal and healthcare payer perspective (reference year 2007). A retrospective standardized assessment of all clinically suspected ABC-HSR cases without screening at 5 German HIV-centres was performed to measure resource consumption. In- and outpatient care, discarded ABC/3TC FDC and concomitant medication were considered. Direct resource utilization was valued using German fees (EBM, G-DRGs). Indirect costs were measured with the human capital approach. Estimates for the HLA-B*5701-prevalence, HSR-incidence, and hospitalization rate were based on clinical trials and cohorts and it was assumed that screening reduces the incidence of clinically suspected ABC-HSR from 10% to 0.5%.</p> <p>Results</p> <p>Thirty-two ABC-HSR cases were identified from 1998 to 2007. Mean direct and total costs per clinically suspected HSR case were € 1,362 and € 2,235, respectively. Hospital costs contributed 63.3% to direct costs. Potential cost savings when implementing genetic screening were estimated at € 44 and € 127 per screened patient, from a healthcare payer or societal perspective.</p> <p>Conclusion</p> <p>HLA-B*5701 screening prior to ABC/3TC FDC initiation prevents significant HSR-related costs per screened patient and is likely to lead to overall net savings.</p> |
| first_indexed | 2024-12-18T06:34:49Z |
| format | Article |
| id | doaj.art-fdf4bac2d4154867a9fb579da17d38ae |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-12-18T06:34:49Z |
| publishDate | 2010-04-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-fdf4bac2d4154867a9fb579da17d38ae2022-12-21T21:17:49ZengBMCEuropean Journal of Medical Research2047-783X2010-04-0115414510.1186/2047-783X-15-4-145Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in GermanyWolf EBlankenburg MBogner JRBecker WGorriahn DMueller MCJaeger HWelte RBaudewig MWalli RStoll M<p>Abstract</p> <p>Objective</p> <p>Avoiding abacavir in HIV-infected patients tested positive for HLA-B*5701 reduces the risk of abacavir hypersensitivity reaction (ABC-HSR). Our aim was to assess the costs of clinically suspected HSR and to estimate potential cost savings of implementing prospective HLA-B*5701-screening for HIV-infected patients initiating abacavir/lamivudine fixed-dose combination (ABC/3TC FDC) compared to initiating respective treatment without screening.</p> <p>Methods</p> <p>Employing a decision tree model the expected HSR-related costs of screening vs. no screening were estimated from the societal and healthcare payer perspective (reference year 2007). A retrospective standardized assessment of all clinically suspected ABC-HSR cases without screening at 5 German HIV-centres was performed to measure resource consumption. In- and outpatient care, discarded ABC/3TC FDC and concomitant medication were considered. Direct resource utilization was valued using German fees (EBM, G-DRGs). Indirect costs were measured with the human capital approach. Estimates for the HLA-B*5701-prevalence, HSR-incidence, and hospitalization rate were based on clinical trials and cohorts and it was assumed that screening reduces the incidence of clinically suspected ABC-HSR from 10% to 0.5%.</p> <p>Results</p> <p>Thirty-two ABC-HSR cases were identified from 1998 to 2007. Mean direct and total costs per clinically suspected HSR case were € 1,362 and € 2,235, respectively. Hospital costs contributed 63.3% to direct costs. Potential cost savings when implementing genetic screening were estimated at € 44 and € 127 per screened patient, from a healthcare payer or societal perspective.</p> <p>Conclusion</p> <p>HLA-B*5701 screening prior to ABC/3TC FDC initiation prevents significant HSR-related costs per screened patient and is likely to lead to overall net savings.</p>http://www.eurjmedres.com/content/15/4/145HLA-B*5701pharmacogenomicsabacavir |
| spellingShingle | Wolf E Blankenburg M Bogner JR Becker W Gorriahn D Mueller MC Jaeger H Welte R Baudewig M Walli R Stoll M Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany European Journal of Medical Research HLA-B*5701 pharmacogenomics abacavir |
| title | Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany |
| title_full | Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany |
| title_fullStr | Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany |
| title_full_unstemmed | Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany |
| title_short | Cost impact of prospective HLA-B*5701-screening prior to abacavir/lamivudine fixed dose combination use in Germany |
| title_sort | cost impact of prospective hla b 5701 screening prior to abacavir lamivudine fixed dose combination use in germany |
| topic | HLA-B*5701 pharmacogenomics abacavir |
| url | http://www.eurjmedres.com/content/15/4/145 |
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