LB960 Clinical and economic trade-offs of non-pregnancy laboratory monitoring in persons on isotretinoin acne therapy

Objective: To project the 1-year clinical and economic trade-offs of current practice versus cessation laboratory monitoring for patients with acne on isotretinoin. Design: Markov model isotretinoin administration comparing: 1) (CP), 2) non-pregnancy (NoLabMon). In simulation, 20-year-old persons initiating were maintained therapy six months, unless taken off early due to abnormalities. Simulated experienced weekly probabilities cell-line abnormalities (0.12%) after detection (2.2%, CP only). Patients serious adverse event (0.1%) mortality (5%). Utilities fully-treated 0.93 (0.89 cessation). We included costs ($110/week), ($5/week), specialist visits ($220/visit) from a healthcare payer perspective. Distributions assigned conduct probabilistic uncertainty analysis (PUA). Results: Over 1 year, 200,000 people in US, NoLabMon resulted 40 additional quality-adjusted life-years (QALYs) compared CP. 1.6 isotretinoin-related deaths strategy 1.9 deaths. Total $819M $795M NoLabMon. was more effective less costly than sensitivity analysis, cost-effectiveness most sensitive variations cost lab abnormality development. No variation single parameter across its plausible range changed our findings. PUA, dominating >99% 10,000 simulations. Conclusions: Laboratory as currently practiced is unlikely be an efficient use resources. Cessation could realize savings $24M/year improve patient outcomes, negligible effects events.