Cost-effectiveness analysis of genotyping for HLA-B*5801 and an enhanced safety program in gout patients starting allopurinol in Singapore.

Journal Article (Journal Article)


Allopurinol is an efficacious urate-lowering therapy (ULT), but is associated with rare serious adverse drug reactions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with higher risk among HLA-B*5801 carriers. We assessed the cost-effectiveness of HLA-B*5801 testing, an enhanced safety program or strategies with both components.


The analysis adopted a health systems perspective and considered Singaporean patients with chronic gout, over a lifetime horizon, using allopurinol or probenecid. The model incorporated SJS/TEN and gout treatment outcomes, allele frequencies, drug prices and other medical costs.


Based on cost-effectiveness threshold of US$50,000 per quality-adjusted life year, HLA-B*5801-guided ULT selection or enhanced safety program was not cost effective. Avoidance of ULTs was the least preferred strategy as uncontrolled gout leads to lower quality-adjusted life years and higher costs.


The analysis underscores the need for biomarkers with higher positive predictive value for SJS/TEN, less expensive genetic tests or safety programs, or more effective gout drugs. .

Full Text

Duke Authors

Cited Authors

  • Dong, D; Tan-Koi, W-C; Teng, GG; Finkelstein, E; Sung, C

Published Date

  • November 2015

Published In

Volume / Issue

  • 16 / 16

Start / End Page

  • 1781 - 1793

PubMed ID

  • 26554739

Electronic International Standard Serial Number (EISSN)

  • 1744-8042

International Standard Serial Number (ISSN)

  • 1462-2416

Digital Object Identifier (DOI)

  • 10.2217/pgs.15.125


  • eng