Cost–Effectiveness of CYP2B6 Genotyping to Optimize Efavirenz Dosing in HIV Clinical Practice

AIMS: To assess the cost-effectiveness of CYP2B6 genotyping to guide efavirenz dosing for initial HIV therapy in the USA. METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) microsimulation model to project quality-adjusted life expectancy and lifetime costs (2014 US dollars) for efavirenz-based HIV therapy with or without CYP2B6 genotyping. We assumed that with genotyping 60% of patients would be eligible to receive lower doses. RESULTS: Current care without CYP2B6 genotyping has an incremental cost-effectiveness ratio >100, 000/QALY compared with genotype-guided dosing, even if lower dosing reduces efficacy. When we assumed generic efavirenz availability, conclusions were similar unless lower dosing reduces efficacy by 6% or more. CONCLUSION: CYP2B6 genotyping can inform efavirenz dosing and decrease HIV therapy cost.