Naslov
Cost-effectiveness of DPYD genotyping prior to fluoropyrimidine-based adjuvant chemotherapy

Autori
Knežević, Sandra ; Janković, Tamara ; Vitezić, Dinko ; Mršić-Pelčić, Jasenka ; Markova-Car, Elitza

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
11th Adriatic Congress of Pharmacoeconomics and Outcomes Research with focus on CEE / - , 2023, 1-1

Skup
11th Adriatic Congress of Pharmacoeconomics and Outcomes Research with focus on CEE

Mjesto i datum
Sofija, Bugarska, 20.04.2023. - 22.04.2023

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Pharmacogenomics, DPYD genotyping, 5-fluorouracil, cost-effectiveness
(Pharmacogenomics, DPYD genotyping, 5-fluorouracil, cost-effectivenes)

Sažetak
Pharmacogenomics can help optimize and personalize pharmaceutical treatments by improving drug efficacy and safety and potentially reducing treatment costs. Adjuvant fluoropyrimidine-based chemotherapy is a frequently used in a great number of neoplasms, especially of 5-fluorouracil (5-FU) and capecitabine (CAP) which are metabolized through dihydropyrimidine dehydrogenase (DPD) enzyme in the liver encoded by DPYD gene. Up to 2-8% of the population (depending on ethnicity) have DPYD variations leading to DPD deficiency and an increased risk of severe toxicity when treated with regular doses. Our aim was to investigate the cost-effectiveness of DPYD genotyping considering its impact on clinical outcome and healthcare costs. The analysis of the literature showed that DPYD genotyping in stage 3 colorectal cancer is a cost- effective strategy that improves survival by 0.0038 QALYs at an ICER of $20, 506/QALY. Probabilistic sensitivity analysis showed that DPYD genotyping was preferred to no screening in 96.2% of iterations, at a willingness-to-pay threshold of $50, 000/QALY. In one retrospective study of 31 patients showed that hospitalization costs related to toxicity of five patients who tested positive for DPYD mutations were €155, 083. The cost of prospectively testing all patients starting first-line 5FU-based therapy over the same period would have been €23, 718, representing a cost saving of €131, 365 through the avoidance of these admissions alone. In conclusion, DPYD genotyping presents a considerable cost-effective method prior to fluropyrimidine-based adjuvant chemotherapy. Adjustment of the treatment dose prevents potentially severe and fatal toxicities and is worth implementing in daily clinical practice.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti, Kliničke medicinske znanosti

POVEZANOST RADA