Prevalence of Abacavir Hypersensitivity Reaction and
Cost-Effectiveness of HLA-B*5701 Screening: A Ten-Year
Experience in The HRH Princess Maha Chakri Sirindhorn
Medical Center
Pattarin Pitakchotiwan BPharm¹, Patcharasarn Linasmita MD², Jirawat Buppanharun MD³, Prasit Upapan MD²,
Niti Wanthong PharmD¹, Woraphot Tantisiriwat MD, MPH³
Affiliation : ¹ Pharmacy Division, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ² Department of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ³ Department of Preventive Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background: Recently, the authors had reported a case with abacavir hypersensitivity reaction (ABC-HSR), the first diagnosed patient at the
HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC). There was no data regarding the incidence or prevalence of ABC-HSR previously
reported in Thailand.
Objective: To study the prevalence of ABC-HSR, the abacavir use pattern and the cost effectiveness for the routine human leukocyte antigen (HLA)-B*5701 screening before abacavir use by analyses of the MSMC data.
Materials and Methods: All patients at the MSMC who were prescribed abacavir from October 1, 2010 to September 30, 2020 were retrospectively reviewed for ABC-HSR and the abacavir use pattern at the time when abacavir was started. The cost-effectiveness analysis was applied by analyzing the cost between the routine HLA-B*5701 screening before abacavir use and the HLA-B*5701 confirmation for ABC-HSR. The cost for the prevention of a case of ABC-HSR was defined.
Results: There were total of 54 patients who were prescribed abacavir and only one ABC-HSR case diagnosed. The prevalence of ABC-HSR was 1.85%. The main reason for the abacavir prescription was a substitution for tenofovir (TDF) because of the TDF adverse effects (81.13%). The HLA-B*5701 screening before abacavir use was done in 26.42% at the MSMC. If all eligible patients were routinely screened for the HLA-B*5701 allele before abacavir use, the cost would be 54,000 Baht. The cost for the diagnosis and the management of the ABC- HSR case was 7,230 Baht. The cost for the prevention of a case of ABC-HSR was 46,770 Baht.
Conclusion: The prevalence of ABC-HSR was low. The main reason for abacavir use was a substitution for TDF. The cost for the prevention for a case of ABC-HSR was 46,770 Baht which would be less if the cost for the HLA-B*5701 test was reduced.
Received 25 June 2021 | Revised 10 September 2021 | Accepted 10 September 2021
doi.org/10.35755/jmedassocthai.2021.10.13128
Keywords :
Abacavir; Hypersensitivity reaction; Prevalence; HLA-B*5701
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