cartouche ECN WORKSHOP

Is it worth a try? Applying economic evaluation to compare febuxostat with the risk of allopurinol induced SJS-TEN


J. Hwang (1), S. K. Cho (2,3)



1. University Of Connecticut School Of Medicine, Farmington, Connecticut, USA
2. Molecular Genetic Epidemiology Section, Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
3. Department of Pharmacology, Ajou University School Of Medicine, Suwon, Republic Of Korea.



Background: Febuxostat is a cost-effective option compared with allopurinol among chronic gout patients in the US from the prior study. Allopurinol induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is commonly observed in Eastern Asian because of human leukocyte antigen, HLA-B*5801 mutation. Little evidence exists for the economic evaluation of febuxostat vs. allopurinol related to allopurinol induced SJS/TEN. This study aims to evaluate the cost-benefit of febuxostat compared to allopurinol use with consideration of SJS/TEN related morbidity and mortality in the US Asian population.

Methods: A decision analytic model was developed to evaluate the cost-benefit of febuxostat use compared with allopurinol use in general care. We estimated the expected expenses of SJS/TEN hospitalizations per discharge in each population considering the incidence, as well as potential life lost cost due to early mortality of SJS/TEN with allopurinol, expected morbidity cost, and risk premium of allopurinol. This study also seeks to characterize the expected costs of SJS/TEN for different populations.

Results: Based on the cost-benefit analysis, our cost estimation shows expected expenses of SJS/TEN hospitalizations per discharge: $14.9 for White patients, $86 for Black patients, and $488 for Asian patients. The productivity cost and potential life lost due to early mortality of allopurinol induced SJS/TEN was $2,611,947. The expected morbidity cost due to allopurinol induced SJS/TEN was $47,422. Overall, the risk premium of allopurinol resulting from allopurinol induced SJS/TEN per Asian patient in US was $1,687.

Conclusions: With consideration of high incidence of SJS/TEN in Eastern Asian patients due to HLA-B*5801, it is imperative to consider these costs of allopurinol-induced SJS/TEN. Febuxostat is not only the cost-effective option but also a much safer treatment for chronic gout management in general practice, especially for Asian population.