| Objective:To get the positive rate of HLA-B*5801 genes and medication information of the patients with hyperuricemia and gout in a single center in Shenzhen.In order to investigate the health economic value of routine screening of HLA-B*5801 genes to guide clinical medication in hyperuricemia and gout patients.Methods:In this retrospective report,we had analyzed the clinical characteristic of 253hyperuricemia and gout patients who had been genotyped HLA-B*5801 in the First Affiliated Hospital of Shenzhen University and analyzed the clinical management of medications.The positive rate of HLA-B*5801 genes was calculated.In 253 patients,a total of 86 patients were found to have incomplete clinical data(39 cases did not have data on the history of gout,44 cases did not have 24-h uric acid values,and three cases did not have eGFR values).These patients were excluded from the analysis.A total of 167 cases had complete clinical information.Group A(both allopurinol and febuxostat could be used and patients with good family financial condition could choose febuxostat directly)included 120patients with eGFR more than 30 ml/min/1.73 m~2.These patients had a history of gout,urolithiasis positivity,and without color ultrascan in the type of reduced uric acid excretion,increased formation of uric acid,and asymptomatic hyperuricemia.Group B(a noncompetitive inhibitor of xanthine oxidase benzbromarone or febuxostat could be used)included 47 cases,with a total of 41 patients having asymptomatic hyperuricemia and reduced uric acid excretion(no kidney stone and eGFR>20 ml/min/1.73 m~2)and six patients with eGFR less than 30 ml/min/1.73 m~2.The patients had a history of gout,urolithiasis positivity,and without color ultrascan in the type of reduced uric acid excretion,increased formation of uric acid,and asymptomatic hyperuricemia.At the time of the research,cost of screening of HLAB*5801 was 800 Renminbi(RMB)yuan.Allopurinol was 0.5 RMB yuan for 0.1 g/tablet per tablet and febuxostat was 20 RMB yuan for 40 mg/tablet per tablet.Model1 represented the initial dosages of allopurinol 100 mg/day and febuxostat 40 mg/day;model2 represented maximum dosages of allopurinol 600 mg/day and febuxostat 80 mg/day.Cost(y1)=time×spending of allopurinol daily amount+test fee of HLA-B*5801.Cost(y2)=time×spending of febuxostat daily amount.To assess which drugs are more economical for patients with hyperuricemia and gout.We also recruited 253 patients to calculate the possible cost for the management of hyperuricemia.Model 3 represented the initial dose of allopurinol100 mg/day and febuxostat 40 mg/day;model 4 represented the maximum dose of allopurinol 600 mg/day and febuxostat 80 mg/day.In model 3 and model 4,we compared the cost of using febuxostat without HLA-B*5801 screening and the cost with HLA-B*5801screening.We defined the administration of medications as standardized usage according to the results of the screening.If HLA-B*5801 was negative,allopurinol would be used for the treatment;if HLAB*5801 was positive,febuxostat would be used for the treatment.The cost of standardized usage of medications included:A:febuxostat cost=[febuxostat amount(y2)+gene test fee]×all×gene positive detection rate and B:allopurinol cost=[allopurinol amount(y1)+gene test fee]×all×gene negative detection rate.The cost without screening HLA-B*5801 and direct use of febuxostat was C:febuxostat cost=spending of daily amount×time.Allopurinol consumption=duration before exfoliative dermatitis×allopurinol daily amount×all×gene positive detection rate×total cost of dermatitis×gene negative detection rate×allopurinol daily amount×time.To evaluate the economic value of routine screening of HLA*B5801 gene before medication.In addition,we checked the records for medication usage for the 253 hyperuricemia and gout patients,to assess whether the clinical use of hyperuricemia and gout patients is standardized,and assess whether the detection of HLA*B5801 gene has guiding value for the correct application of drugs.Results:In 253 patients,we identified 30 HLA-B*5801 carriers;the HLA-B*5801positive rate were 11.9%in the total screening patients.In group A,15%(18/120)of patients were carriers of HLA-B*5801 and in group B,12.8%(6/47)of patients were carriers of HLA-B*5801.There was no any difference in the HLA-B*5801 carriers between two groups.Drug information was obtained from 253 patients with 243 patients,of which HLA-B*5801gene positive groups accounted for 11.9%(29/243),and HLA-B*5801 gene negative group included 88.1%(214/243).In the gene-positive group,one patient used allopurinol,seven patients used febuxostat,two patients used benzbromarone,and five patients used other drugs(non-steroidal anti-inflammatory drugs,sodium bicarbonate,Colchicine,14 patients reduced uric acid through diet and other lifestyles;in the gene-negative group,allopurinol was used in44 patients,febuxostat was used in 29 patients,and benzbromarone was used in 19 patients,38 The patient used other drugs(non-steroidal anti-inflammatory drugs,sodium bicarbonate,colchicine),and 84 patients reduced uric acid through lifestyle such as eating.In model 1,allopurinol and febuxostat were used at the lowest dosages.The cost would be higher in the first 42 days for the allopurinol group of testing for the genotype of HLA-B*5801.After 42days,it would significantly save the money for the patients with the genotype screening.There would be a saving of 2749 yuan per patient for half a year and 6317.5 yuan for 1 year of treatment.In model 2,allopurinol and febuxostat were used at the highest dosages.The cost would be higher in the first 22 days for allopurinol with testing for the genotype of HLA-B*5801.After 22 days,there would be significant cost savings for the patients with the group.There would be a saving of 5934 yuan per patient for half a year and a saving of 12705 yuan for 1 year of treatment.In model 3,the costs of allopurinol and febuxostat at the lowest dosages in all 253 patients were calculated.The costs of standard medication would be higher in the first 47 days for the cost of direct use of febuxostat.After 47 days,it could significantly save the money for the group.There would a saving of 588 647.3 yuan for half a year and a saving of 1 384 040.9 yuan for 1 year of treatment.In model 4,allopurinol and febuxostat were used at the highest dosages in all 253 patients.The standard medication cost would be higher in the first 25 days for the cost of direct use of febuxostat.After 25 days,it could significantly save any money for the group.It would result in the saving of 1 298 561.5yuan for half a year and a saving of 2 807 770.0 yuan for 1 year of treatment.Using allopurinol directly without screening HLAB*5801,the cost for the treatment of all 253patients could be even higher as severe skin allergies and other severe conditions would require much more resources for treatment.Conclusion:The positive rate of HLA-B*5801 genes in patients with hyperuricemia and gout in Shenzhen was 11.9%,which is equivalent to that in Taiwan(10.4%)which has been required to screen the gene.Shenzhen as an immigrant city,its positive rate may be a reference for mainland China.Drug information analysis showed that allopurinol was used in both positive and negative patients,which proved that the screening of HLA-B*5801 gene was beneficial to the correct application of allopurinol and febuxostat in the clinical treatment of patients with hyperuricemia and gout.The model analysis showed that the use of allopurinol and the detection of HLA-B*5801 gene had good economic value for hyperuricemia and gout patients who needed long-term treatment and poor economic conditions.In summary,patients with hyperuricemia and gout in Chinese Han population should be screened for the HLA-B*5801 gene,which is of reference value for the development of a modern Chinese guideline.Febuxostat can be used in patients with inadequate effect of allopurinol,HLA-B*5801 positive,severe renal insufficiency,and good economic conditions. |
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