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Cost implications of reactive versus prospective testing for dihydropyrimidine dehydrogenase deficiency in patients with colorectal cancer: A single-institution experience
Murphy, Con; Byrne, Stephen; Ahmed, Gul; Kenny, Andrew; Gallagher, James; Harvey, Harry; O'Farrell, Eoin; Bird, Brian
Background:Severe toxicity is experienced by a substantial minority of patients receiving fluoropyrimidine-based chemotherapy, with approximately 20% of these severe toxicities attributable to polymorphisms in the DPYD gene. The DPYD codes for the enzyme dihydropyrimidine dehydrogenase (DPD) important in the metabolism of fluoropyrimidine-based chemotherapy. We questioned whether prospective DPYD mutation analysis in all patients commencing such therapy would prove more cost-effective than reactive testing of patients experiencing severe toxicity.Methods:All patients experiencing severe toxicity from fluoropyrimidine-based chemotherapy for colorectal cancer in an Irish private hospital over a 3-year period were tested for 4 DPYD polymorphisms previously associated with toxicity. The costs associated with an index admission for toxicity in DPD-deficient patients were examined. A cost analysis was undertaken comparing the anticipated cost of implementing screening for DPYD mutations versus current usual care. One-way sensitivity analysis was conducted on known input variables. An alternative scenario analysis from the perspective of the Irish health-care payer (responsible for public hospitals) was also performed.Results:Of 134 patients commencing first-line fluoropyrimidine chemotherapy over 3 years, 30 (23%) patients developed grade 3/4 toxicity. Of these, 17% revealed heterozygote DPYD mutations. The cost of hospitalization for the DPYD-mutated patients was ?232 061, while prospectively testing all 134 patients would have cost ?23 718. Prospective testing would result in cost savings across all scenarios.Conclusions:The cost of hospital admission for severe chemotherapy-related toxicity is significantly higher than the cost of prospective DPYD testing of each patient commencing fluoropyrimidine chemotherapy.
Keyword(s): DPYD; Fluoropyrimidine; Colorectal cancer; Cost-effectiveness; Pharmacogenomics
Publication Date:
2018
Type: Journal article
Peer-Reviewed: Yes
Language(s): English
Institution: University College Cork
Citation(s): Murphy, C., Byrne, S., Ahmed, G., Kenny, A., Gallagher, J., Harvey, H., O’Farrell, E. and Bird, B., 2018. Cost implications of reactive versus prospective testing for dihydropyrimidine dehydrogenase deficiency in patients with colorectal cancer: a single-institution experience. Dose-Response, 16(4), (1559325818803042). DOI:10.1177/1559325818803042
Publisher(s): Sage Publications Ltd
File Format(s): application/pdf
Related Link(s): https://journals.sagepub.com/doi/10.1177/1559325818803042
First Indexed: 2019-10-03 06:30:12 Last Updated: 2019-11-05 06:33:58