Cost-effectiveness analysis of HLA B*5701 genotyping in preventing abacavir hypersensitivity

Pharmacogenetics. 2004 Jun;14(6):335-42. doi: 10.1097/00008571-200406000-00002.


Objective: Abacavir, a human immunodeficiency virus-1 (HIV-1) nucleoside-analogue reverse transcriptase inhibitor, causes severe hypersensitivity in 4-8% of patients. HLA B*5701 is a known genetic risk factor for abacavir hypersensitivity in Caucasians. Our aim was to confirm the presence of this genetic factor in our patients, and to determine whether genotyping for HLA B*5701 would be a cost-effective use of healthcare resources.

Methods: Patients with and without abacavir hypersensitivity were identified from a UK HIV clinic. Patients were genotyped for HLA B*5701, and pooled data used for calculation of test characteristics. The cost-effectiveness analysis incorporated the cost of testing, cost of treating abacavir hypersensitivity, and the cost and selection of alternative antiretroviral regimens. A probabilistic decision analytic model (comparing testing versus no testing) was formulated and Monte Carlo simulations performed.

Results: Of the abacavir hypersensitive patients, six (46%) were HLA B*5701 positive, compared to five (10%) of the non-hypersensitive patients (odds ratio 7.9 [95% confidence intervals 1.5-41.4], P = 0.006). Pooling of our data on HLA B*5701 with published data resulted in a pooled odds ratio of 29 (95% CI 6.4-132.3; P < 0.0001). The cost-effectiveness model demonstrated that depending on the choice of comparator, routine testing for HLA B*5701 ranged from being a dominant strategy (less expensive and more beneficial than not testing) to an incremental cost-effectiveness ratio (versus no testing) of Euro 22,811 per hypersensitivity reaction avoided.

Conclusions: Abacavir hypersensitivity is associated with HLA B*5701, and pre-prescription pharmacogenetic testing for this appears to be a cost-effective use of healthcare resources.

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Dideoxynucleosides / adverse effects
  • Dideoxynucleosides / economics*
  • Drug Hypersensitivity / economics*
  • Drug Hypersensitivity / genetics
  • Drug Hypersensitivity / prevention & control*
  • Female
  • Genotype
  • HIV Infections / drug therapy
  • HIV Infections / economics*
  • HIV Infections / immunology
  • HIV-1
  • HLA-B Antigens / economics*
  • HLA-B Antigens / genetics
  • Humans
  • Male
  • Middle Aged
  • Molecular Diagnostic Techniques / economics
  • Monte Carlo Method
  • Odds Ratio
  • Pharmacogenetics / economics
  • Point-of-Care Systems / economics
  • Reverse Transcriptase Inhibitors / adverse effects
  • Reverse Transcriptase Inhibitors / economics*
  • Risk Factors


  • Dideoxynucleosides
  • HLA-B Antigens
  • HLA-B*57:01 antigen
  • Reverse Transcriptase Inhibitors
  • abacavir