Rheumatology Advance Access originally published online on August 15, 2003
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Rheumatology 2004; 43: 156-163
© British Society for Rheumatology 2003; all rights reserved
Basic Science |
Pharmacoeconomic analysis of thiopurine methyltransferase polymorphism screening by polymerase chain reaction for treatment with azathioprine in Korea
Department of Internal Medicine, Division of Rheumatology, Hanyang University College of Medicine and the Hospital for Rheumatic Diseases, Hanyang University Medical Center, Seoul, Republic of Korea and 1Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Correspondence to: S.-C. Bae, The Hospital for Rheumatic Diseases, Hanyang University Medical Center, Seoul 133–792, Republic of Korea. E-mail: scbae@hanyang.ac.kr
Objectives. To evaluate the value of genotype-based dosing by polymerase chain reaction (PCR)-based polymorphism screening in terms of cost-effectiveness for treatment with azathioprine in Korea.
Methods. Decision analysis was employed to compare a genotype-based dosing strategy with the conventional weight-based dosing strategy using a hypothetical cohort composed of rheumatoid arthritis and systemic lupus erythematosus patients. The time horizon was set up as 1 yr. Direct medical costs were used. Data used were obtained from previous reports, except for PCR and admission costs, which were from real cases. Cost-effectiveness analysis was conducted from a societal perspective. Outcomes were measured as a total expected cost and an incremental cost-effective ratio.
Results. In the base case model, total expected cost and the probability of not dropping out owing to serious adverse events of the conventional weight-based dosing and the genotype-based dosing strategy were 1339x103 Korean won ($US 1117) and 1109x103 Korean won ($US 926), and 97.06 and 99.90%, respectively.
Conclusions. Our model suggests that a genotype-based dosing strategy through PCR-based thiopurine methyltransferase (TPMT) polymorphism screening is less costly and more effective than the conventional weight-based dosing strategy in Korea, as it was associated with a marked reduction in the number of serious adverse events.
KEY WORDS: Thiopurine methyltransferase, Polymorphism, Screening, Polymerase chain reaction, Azathioprine, Pharmacoeconomic analysis, Korea.
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