Antivir Ther. 2012 Dec 21. doi: 10.3851/IMP2500. [Epub ahead of print]
Cost-effectiveness analysis of UGT1A1 genetic testing to inform antiretroviral prescribing in HIV disease.
SourceDepartment of Public Health, Weill Cornell Medical College, New York, NY, USA. firstname.lastname@example.org.
BACKGROUND:Homozygosity for UGT1A1*28/*28 (Gilbert's variant) has been reported to be associated with atazanavir-associated hyperbilirubinemia and premature atazanavir discontinuation. We assessed the potential cost-effectiveness of UGT1A1 testing to inform choice of an initial protease inhibitor-containing regimen in antiretroviral therapy (ART)-naïve individuals.
METHODS:We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model to project quality-adjusted life years (QALYs) and lifetime costs (2009 US dollars) for atazanavir-based ART with or without UGT1A1 testing, using darunavir rather than atazanavir when indicated. We assumed UGT1A1-associated atazanavir discontinuation rates reported in the Swiss HIV Cohort Study, a *28/*28 frequency of 14.9%, equal efficacy and cost of atazanavir and darunavir, and genetic assay cost of $107. Sensitivity analyses varied these parameters and hyperbilirubinemia impact on quality of life and loss to follow-up (LTFU). Costs and QALYs were discounted at 3% annually.
RESULTS:Initiating atazanavir-based ART at CD4 <500 0.49="0.49" 10="10" 16.02="16.02" an="an" and="and" average="average" by="by" cost-effective="cost-effective" cost.="cost." discounted="discounted" expectancy="expectancy" for="for" had="had" increased="increased" l="l" life="life" lifetime="lifetime" not="not" of="of" patients="patients" per="per" qalys="qalys" tested="tested" testing="testing" ugt1a1="ugt1a1" was="was" without="without">$100,000/QALY). Testing for UGT1A1 was cost-effective (<$100,000/QALY) if assay cost decreased to $10, or if avoiding hyperbilirubinemia by UGT1A1 testing reduced LTFU by 5%. If atazanavir and darunavir differed in cost or efficacy, testing for UGT1A1 was not cost-effective under any scenario.500>
CONCLUSIONS:Testing for UGT1A1 may be cost-effective if assay cost is low and if testing improves retention in care, but only if the comparator ART regimens have the same drug cost and efficacy.
- [PubMed - as supplied by publisher]