Cost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice.

TitleCost-effectiveness of CYP2B6 genotyping to optimize efavirenz dosing in HIV clinical practice.
Publication TypeJournal Article
Year of Publication2015
AuthorsSchackman BR, Haas DW, Park SS, X Li C, Freedberg KA
JournalPharmacogenomics
Volume16
Issue18
Pagination2007-18
Date Published2015 Dec
ISSN1744-8042
KeywordsAnti-HIV Agents, Benzoxazines, Cost-Benefit Analysis, Cytochrome P-450 CYP2B6, Genotype, Genotyping Techniques, HIV Infections, Humans, Models, Theoretical, Quality-Adjusted Life Years
Abstract

AIMS: To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA.

METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses.

RESULTS: Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >$100,000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more.

CONCLUSION: CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.

DOI10.2217/pgs.15.142
Alternate JournalPharmacogenomics
PubMed ID26607811
PubMed Central IDPMC4832977
Grant ListUL1 TR000445 / TR / NCATS NIH HHS / United States
R37 AI042006 / AI / NIAID NIH HHS / United States
R01 AI077505 / AI / NIAID NIH HHS / United States
U01 AI069439 / AI / NIAID NIH HHS / United States
UM1 AI069439 / AI / NIAID NIH HHS / United States
R37AI42006 / AI / NIAID NIH HHS / United States
AI069439 / AI / NIAID NIH HHS / United States
P30 AI110527 / AI / NIAID NIH HHS / United States
AI110527 / AI / NIAID NIH HHS / United States
TR000445 / TR / NCATS NIH HHS / United States