Cost implications of reactive versus prospective testing for dihydropyrimidine dehydrogenase deficiency in patients with colorectal cancer: A single-institution experience

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dc.contributor.author Murphy, Con
dc.contributor.author Byrne, Stephen
dc.contributor.author Ahmed, Gul
dc.contributor.author Kenny, Andrew
dc.contributor.author Gallagher, James
dc.contributor.author Harvey, Harry
dc.contributor.author O'Farrell, Eoin
dc.contributor.author Bird, Brian
dc.date.accessioned 2019-10-02T04:36:50Z
dc.date.available 2019-10-02T04:36:50Z
dc.date.issued 2018-10-01
dc.identifier.citation 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 en
dc.identifier.volume 16 en
dc.identifier.issued 4 en
dc.identifier.startpage 1 en
dc.identifier.endpage 6 en
dc.identifier.uri http://hdl.handle.net/10468/8659
dc.identifier.doi 10.1177/1559325818803042 en
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Sage Publications Ltd en
dc.relation.uri https://journals.sagepub.com/doi/10.1177/1559325818803042
dc.rights © The Author(s) 2018 en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ en
dc.subject DPYD en
dc.subject Fluoropyrimidine en
dc.subject Colorectal cancer en
dc.subject Cost-effectiveness en
dc.subject Pharmacogenomics en
dc.title Cost implications of reactive versus prospective testing for dihydropyrimidine dehydrogenase deficiency in patients with colorectal cancer: A single-institution experience en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Stephen Byrne, School of Pharmacy, University College Cork, Cork, Ireland. +353-21-490-3000 Email: stephen.byrne@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Dose-Response en
dc.internal.IRISemailaddress stephen.byrne@ucc.ie en
dc.identifier.articleid 1559325818803042 en
dc.identifier.eissn 1559-3258


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