Real-World Efficiency of Pharmacogenetic Screening for Carbamazepine-Induced Severe Cutaneous Adverse Reactions

<div><p>Objectives</p><p>We evaluated the cost and efficiency of routine HLA-B*15∶02 screening to prevent carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (CBZ-SJS/TEN) in Hong Kong.</p><p>Methods</p><p>Data were extracted from patients who commenced CBZ as the first-ever AED treatment or tested for HLA-B*15∶02 allele in three years before policy implementation (pre-policy: 16 September 2005 to 15 September 2008) and three years after (post-policy: 16 September 2008 to 15 September 2011). Using published unit costs, we estimated the cost of screening by comparing the costs to prevent and treat CBZ-SJS/TEN. We compared the number of person-tests needed and the cost to prevent resultant death with cancer screening programs.</p><p>Results</p><p>The number of screening tests needed to prevent one case of CBZ-SJS/TEN was 442, and to prevent one resultant death was 1,474 to 8,840. The screening cost was $332 per person, of which 42$146,749 to prevent a case of CBZ-SJS/TEN, and $489,386–$2,934,986 to prevent a resultant death. The corresponding numbers of tests and costs for mammography and Pap smear to prevent death due to breast and cervical cancers were 7,150 and 7,000, and $614,900 and$273,000, respectively. Comparing to the SJS/TEN treatment cost, HLA-B*15∶02 screening would become cost saving if a point-of-care test of less than $37 was available.</p><p>Conclusions</p><p>HLA-B*15∶02 screening is as efficient as mammography and Pap smear in preventing death. Development of point-of-care testing will vastly improve efficiency.</p></div

Number of person-tests of HLA-B*15∶02 screening compared to mammography and Pap smear.

1<p>Overall SJS/TEN mortality rate ranged from 5% to 30%.</p>2<p>Based on the recommended biennial screening for 20 years from aged 50 years and detection of one case per 715 persons screened over this period. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096990#pone.0096990-Warner1" target="_blank">[25]</a> Number excluded 20% non-compliance rate that was assumed in the original report.</p>3<p>Based on the recommended quinquennial screening for 35 years from aged 24 years and detection of one case per 1000 persons screened over this period. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096990#pone.0096990-Raffle1" target="_blank">[26]</a>.</p

Clinicians’ adherence to international guidelines in the clinical care of adults with inflammatory bowel disease

<p><b>Background:</b> Although evidence-based guidelines have been developed for inflammatory bowel disease (IBD), the extent to which they are followed is unclear. The objective of this study was to review clinicians’ adherence to international IBD guidelines.</p> <p><b>Methods:</b> Retrospective data collection of patients attending a tertiary Australian hospital IBD clinic over a 12-month period. Management practices were audited and compared to ECCO (European Crohn’s and Colitis Organization) guidelines.</p> <p><b>Results:</b> Data from 288 patients were collected: 47% (136/288) male; mean age 43; 140/288 (49%) patients had ulcerative colitis (UC); 145/288 (50%) patients had Crohn’s disease (CD); 3/288 (1%) patients had IBD-unclassified (IBD-U). Patient care was undertaken by gastroenterologists, trainees and general practitioners. <i>Disease Management:</i> Overall adherence to disease management guidelines occurred in 204/288 (71%) of patient encounters. Discrepancies between guidelines and management were found in: 25/80 (31%) of patients with UC in remission receiving oral 5-aminosalicyclates (5-ASAs) as maintenance therapy, and; 46/110 (42%) of patients with small bowel and/or ileo-cecal CD receiving 5-ASA. <i>Preventive Care:</i> Adherence to ≥1 additional component of preventive care was observed in 73/288 (25%) of patient encounters: 12/133 (9%) on thiopurines underwent annual skin checks; 61/288 (21%) of patients with IBD underwent a bone scan; 46/288 (16%) patients were reminded to have their influenza vaccine. <i>Psychological care:</i> Assessment of psychological wellbeing was undertaken in only 16/288 (6%) of patients.</p> <p><b>Conclusions:</b> There remains a gap between adherence to international guidelines and clinical practice. Standardizing practice using evidence-based clinical pathways may be a strategy towards improving the quality of IBD outpatient management.</p

Cost of HLA-B*15∶02 screening compared with mammography and Pap smear.

1<p>Upper-limit cost of HLA-B*15∶02 screening to prevent one death was estimated from overall SJS/TEN mortality rate at 5%, and 30% mortality rate was used for lower-limit.</p>2<p>Costs were converted from UK sterling to US dollars using the May 2004 exchange rate of £0.56 to $1.</p>†<p>Excluded costs of diagnostic screening, biopsy and all subsequent procedures if any abnormality was found.</p>#<p>Cost for an additional consultation was included based on the observed 98.6% non-same-day test turnaround rate.</p><p>SJS, Stevens-Johnson Syndrome; TEN, toxic epidermal necrolysis.</p

sj-docx-1-hpq-10.1177_13591053231164499 – Supplemental material for Novel behaviour change frameworks for digital health interventions: A critical review

Supplemental material, sj-docx-1-hpq-10.1177_13591053231164499 for Novel behaviour change frameworks for digital health interventions: A critical review by Melissa Pelly, Farhad Fatehi, Danny Liew and Antonio Verdejo-Garcia in Journal of Health Psychology</p

sj-docx-2-hpq-10.1177_13591053231164499 – Supplemental material for Novel behaviour change frameworks for digital health interventions: A critical review

Supplemental material, sj-docx-2-hpq-10.1177_13591053231164499 for Novel behaviour change frameworks for digital health interventions: A critical review by Melissa Pelly, Farhad Fatehi, Danny Liew and Antonio Verdejo-Garcia in Journal of Health Psychology</p

sj-csv-4-hpq-10.1177_13591053231164499 – Supplemental material for Novel behaviour change frameworks for digital health interventions: A critical review

Supplemental material, sj-csv-4-hpq-10.1177_13591053231164499 for Novel behaviour change frameworks for digital health interventions: A critical review by Melissa Pelly, Farhad Fatehi, Danny Liew and Antonio Verdejo-Garcia in Journal of Health Psychology</p

sj-csv-3-hpq-10.1177_13591053231164499 – Supplemental material for Novel behaviour change frameworks for digital health interventions: A critical review

Supplemental material, sj-csv-3-hpq-10.1177_13591053231164499 for Novel behaviour change frameworks for digital health interventions: A critical review by Melissa Pelly, Farhad Fatehi, Danny Liew and Antonio Verdejo-Garcia in Journal of Health Psychology</p

Additional file 1: of Evaluating optimal utilisation of technology in type 1 diabetes mellitus from a clinical and health economic perspective: protocol for a systematic review

Search terms incorporating RCT and economics filters. Search terms were designed for MEDLINE® with daily update and MEDLINE® in-process and other non-indexed citations (via OvidSP). Modifications to search filters for ‘trials’ [35] and ‘economics’ [36] were made. (DOCX 17 kb

Additional file 2: of Evaluating optimal utilisation of technology in type 1 diabetes mellitus from a clinical and health economic perspective: protocol for a systematic review

Populated PRISMA-P checklist [16]. (DOCX 29 kb