{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:13:05Z","timestamp":1790745185537,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,6,3]],"date-time":"2019-06-03T00:00:00Z","timestamp":1559520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Carbamazepine, widely used in the treatment of partial and generalized tonic\u2013clonic seizures, has been associated with life\u2010threatening Stevens\u2010Johnson syndrome\/toxic epidermal necrolysis among some Asians. The HLA\u2010B*1502 genotype that occurs with varying frequency among Asians is recommended for screening prior to starting carbamazepine. Our goal is to explore the cost\u2010effectiveness of screening for the presence of this genetic allele.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We constructed a Markov model in a hypothetical cohort of adult Asian patients with epilepsy in the United States being considered for carbamazepine to investigate the cost\u2010effectiveness of two alternative strategies: (1) no HLA\u2010B*1502 gene allele screening and using carbamazepine and (2) HLA\u2010B*1502 gene allele screening and starting levetiracetam in the case of a positive screen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the lifetime horizon, HLA\u2010B*1502 gene screening was the cost\u2010effective choice compared to no gene screening, with an incremental cost\u2010effectiveness ratio of $27\u00a0058 per quality\u2010adjusted life\u2010year (QALY), below the $50\u00a0000\/QALY threshold in 99.69% of probabilistic sensitivity analyses. Although gene screening strategy was more expensive than a no screening strategy, it was more effective, yielding more QALYs, across all Asian ethnic groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Our analysis confirms the 2007 US Food and Drug Administration recommendation to screen for HLA\u2010B*1502 allele before starting treatment with carbamazepine in patients of Asian ancestry in the United States.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.16053","type":"journal-article","created":{"date-parts":[[2019,6,3]],"date-time":"2019-06-03T16:03:57Z","timestamp":1559577837000},"page":"1472-1481","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Cost\u2010effectiveness of screening for HLA\u2010B*1502 prior to initiation of carbamazepine in epilepsy patients of Asian ancestry in the United States"],"prefix":"10.1111","volume":"60","author":[{"given":"Hyunmi","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Neurology Columbia University New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6059-6681","authenticated-orcid":false,"given":"Babak","family":"Mohit","sequence":"additional","affiliation":[{"name":"Center for Evaluation of Value and Risk in Health Tufts Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12074"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-4362.1998.00490.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0305-4179(95)00140-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/428486a"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2010.04745.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01719.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2007.01022.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/0378-6323.57718"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02533.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02269.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.2217\/14622416.9.11.1617"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2011.08.010"},{"key":"e_1_2_9_14_1","unstructured":"US Food and Drug Administration.Safety alerts for drugs biologics medical devices and dietary supplements 2008.2017. 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