Murphy C, Byrne S, Ahmed G, Kenny A, Gallagher J, Harvey H, O'Farrell E, Bird B. Cost Implications of Reactive Versus Prospective Testing for Dihydropyrimidine Dehydrogenase Deficiency in Patients With Colorectal Cancer: A Single-Institution Experience.
Dose Response 2018;
16:1559325818803042. [PMID:
30288154 PMCID:
PMC6168732 DOI:
10.1177/1559325818803042]
[Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
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.
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