Rheumatology Advance Access published online on August 15, 2003
Rheumatology, doi:10.1093/rheumatology/keh001
Rheumatology © British Society for Rheumatology 2003; all rights reserved
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Original Papers
1 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
Received 15 March 2003
; accepted 7 July 2003
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.
Pharmacoeconomic analysis of thiopurine methyltransferase polymorphism screening by polymerase chain reaction for treatment with azathioprine in Korea
2 Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada
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