Cost-effectiveness Analysis of HLA-B*58:01 Gene Polymorphism Detection before Gout Patients Using Allopurinol or Febuxostat / 中国药房

ABSTRACT

OBJECTIVE:To provide reference for optimizing gout drug therapy plan. METHODS:A total of 107 patients met gout clinical diagnosis criteria in the Affiliated Hospital of Putian University during Jul. 1st,2016- Jul. 1st,2017 were divided into group A and B according to carrying out HLA-B*58:01 gene detection or not. Group A was divided into positive and negative subgroup according to the results of gene detection. Positive subgroup was given febuxostat 40 mg,qd. Negative subgroup was given allopurinol 300 mg,tid with a treatment course for 2 weeks,the level of uric acid was detected after a treatment course;febuxostat was given instead if the level of uric acid was not up to the standard. Group B was given allopurinol;after a treatment course,the level of uric acid was detected;febuxostat was given instead (usage and dosage as group A) if the level of uric acid was not up to the standard. Both groups were treated for 6 months. The levels of uric acid were investigated in 2 groups before and after treatment so as to evaluate up-to-standard rate of treatment. European 5-D health scale of 2 groups were followed up with telephone to calculate therapeutic efficacy by QALY. Cost-effectiveness of 2 groups were calculated,and sensitivity analysis was conducted. RESULTS:Before treatment,there was no statistical significance in urine acid levels between 2 groups (P>0.05). After treatment,urine acid levels of 2 groups were significantly lower than before treatment with statistical significance(P<0.05). Therapeutic effectiveness was 0.818 QALY in group A and 0.808 QALY in group B,without statistical significance between 2 groups(P>0.05). The cost of group A was 3932.46 yuan,and that of group B was 2174.92 yuan. Cost-effectiveness ratio of 2 groups were 4807.41 and 2691.73,and group A was significantly higher than group B. The therapy plan of group B showed that cost-effectiveness advantage. Sensitivity analysis supported the results. There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:It shows cost-effectiveness advantage to directly use allopurinol without gene detection in gout patients.