Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.

<h4>Objectives</h4>We evaluated the cost and efficiency of routine HLA-B*15 ∶ 02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.<h4>Methods</h4>Data were extracted from patients who commenced CBZ a...

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Autores principales:	Zhibin Chen, Danny Liew, Patrick Kwan
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/60c1a95d0888499dbda5503d5f24e8f6
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spelling	oai:doaj.org-article:60c1a95d0888499dbda5503d5f24e8f62021-11-18T08:20:18ZReal-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.1932-620310.1371/journal.pone.0096990https://doaj.org/article/60c1a95d0888499dbda5503d5f24e8f62014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24806465/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>We evaluated the cost and efficiency of routine HLA-B15 ∶ 02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.<h4>Methods</h4>Data were extracted from patients who commenced CBZ as the first-ever AED treatment or tested for HLA-B15 ∶ 02 allele in three years before policy implementation (pre-policy: 16 September 2005 to 15 September 2008) and three years after (post-policy: 16 September 2008 to 15 September 2011). Using published unit costs, we estimated the cost of screening by comparing the costs to prevent and treat CBZ-SJS/TEN. We compared the number of person-tests needed and the cost to prevent resultant death with cancer screening programs.<h4>Results</h4>The number of screening tests needed to prevent one case of CBZ-SJS/TEN was 442, and to prevent one resultant death was 1,474 to 8,840. The screening cost was $332 per person, of which 42% was attributed to an additional consultation to review result and prescribe appropriate medication. HLA-B15 ∶ 02 screening expended $146,749 to prevent a case of CBZ-SJS/TEN, and $489,386- $2,934,986 to prevent a resultant death. The corresponding numbers of tests and costs for mammography and Pap smear to prevent death due to breast and cervical cancers were 7,150 and 7,000, and $614,900 and $273,000, respectively. Comparing to the SJS/TEN treatment cost, HLA-B15 ∶ 02 screening would become cost saving if a point-of-care test of less than $37 was available.<h4>Conclusions</h4>HLA-B*15 ∶ 02 screening is as efficient as mammography and Pap smear in preventing death. Development of point-of-care testing will vastly improve efficiency.Zhibin ChenDanny LiewPatrick KwanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 5, p e96990 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Zhibin Chen Danny Liew Patrick Kwan Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
description	<h4>Objectives</h4>We evaluated the cost and efficiency of routine HLA-B15 ∶ 02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.<h4>Methods</h4>Data were extracted from patients who commenced CBZ as the first-ever AED treatment or tested for HLA-B15 ∶ 02 allele in three years before policy implementation (pre-policy: 16 September 2005 to 15 September 2008) and three years after (post-policy: 16 September 2008 to 15 September 2011). Using published unit costs, we estimated the cost of screening by comparing the costs to prevent and treat CBZ-SJS/TEN. We compared the number of person-tests needed and the cost to prevent resultant death with cancer screening programs.<h4>Results</h4>The number of screening tests needed to prevent one case of CBZ-SJS/TEN was 442, and to prevent one resultant death was 1,474 to 8,840. The screening cost was $332 per person, of which 42% was attributed to an additional consultation to review result and prescribe appropriate medication. HLA-B15 ∶ 02 screening expended $146,749 to prevent a case of CBZ-SJS/TEN, and $489,386- $2,934,986 to prevent a resultant death. The corresponding numbers of tests and costs for mammography and Pap smear to prevent death due to breast and cervical cancers were 7,150 and 7,000, and $614,900 and $273,000, respectively. Comparing to the SJS/TEN treatment cost, HLA-B15 ∶ 02 screening would become cost saving if a point-of-care test of less than $37 was available.<h4>Conclusions</h4>HLA-B*15 ∶ 02 screening is as efficient as mammography and Pap smear in preventing death. Development of point-of-care testing will vastly improve efficiency.
format	article
author	Zhibin Chen Danny Liew Patrick Kwan
author_facet	Zhibin Chen Danny Liew Patrick Kwan
author_sort	Zhibin Chen
title	Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
title_short	Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
title_full	Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
title_fullStr	Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
title_full_unstemmed	Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
title_sort	real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/60c1a95d0888499dbda5503d5f24e8f6
work_keys_str_mv	AT zhibinchen realworldefficiencyofpharmacogeneticscreeningforcarbamazepineinducedseverecutaneousadversereactions AT dannyliew realworldefficiencyofpharmacogeneticscreeningforcarbamazepineinducedseverecutaneousadversereactions AT patrickkwan realworldefficiencyofpharmacogeneticscreeningforcarbamazepineinducedseverecutaneousadversereactions
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Real-world efficiency of pharmacogenetic screening for carbamazepine-induced severe cutaneous adverse reactions.

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