Ανάλυση κόστους - αποτελεσματικότητας του ελέγχου DPYD γονότυπου σε σχέση με το κόστος τοξικότητας από χημειοθεραπεία σε ογκολογικούς ασθενείς

Τζερεφού, Κυριακή

Cost-effectiveness analysis of DPYD genotyping in relation to cost of chemotherapy toxicity in oncology patients

Master Thesis

Author

Τζερεφού, Κυριακή

Date

2024-10-24

Abstract

Background: Colorectal cancer is a type of cancer that affects the colon and the rectum. It is the third most common cancer in men and women worldwide and the main risk factors are increasing age, family history, lifestyle including diet, obesity, reduced physical activity and smoking. Most patients with colon cancer are treated with cytotoxic and targeted biologic agents. Fluoropyrimidines (5-fluorouracil, capecitabine and tegafur) are among the most widely used antineoplastic drugs and they are treated as first-line chemotherapy of metastatic disease. However, patients treated with fluoropyrimidines experienced severe adverse events due to their high toxicity. In recent years, the field of pharmacogenomics has made a significant contribution to the reduction of toxicity, through the control of the fluoropyrimidine metabolism test, which is done with the DPYD PGx genetic test. Patients who have an abnormal DPYD genotype indicate 5-fluorouracil toxicity. DPYD genotyping leads to the reduction of the risk of fluoropyrimidine-induced severe toxicity. According to the global literature, DPYD genotyping seems to be a cost-effective method that increases survival and quality-adjusted life year (QALY) in colon cancer patients treated with fluoropyrimidines. Method: A total of 166 patients aged 33-85 years with colon cancer who were treated with fluoropyrimidines were examined. Of the 166 patients, 79 patients were tested for DPYD genotype (study group) and 87 patients were not tested for mutations in the DPYD gene (control group). The aim was to evaluate the utility, costs and effectiveness of DPYD genotyping in toxicity resulting from fluoropyrimidine therapy in patients with colon cancer. Finally, α bootstrapping analysis was performed to estimate the distribution of QALYs and cost statistics in the present study. Results: Data from a total of 164 colon cancer patients treated with fluoropyrimidines were reviewed. Estimated survival was 466 days in the control group and 513 days in the study group. Also, the adjusted utility in terms of “utilities” ranged from 0.19 to 0.92 in the control group with a value of 0.66, while the adjusted utility was calculated from 0.34 to 0.84 with a mean range of 0.63 in the study group. For the calculation of QALYs, total study days were adjusted to 365 days with a mean of 1.19 years in the control group and 1.2 years in the study group. As per calculations, QALYs for patients who did not undergo DPYD genotyping were 0.79 QALYs per year, while the QALYs for patients who underwent DPYD genomic testing for any DPYD genetic variant was 0.80 QALYs per year. The average total cost of the PGx-guided arm was estimated at €240 and €430 in the control arm indicating a difference of €190 in favor of the PGx-guided arm. The direct costs are the same for both groups of the study. More precisely, hospitalization cost was estimated as the main cost and for the PGx-guided and control arms, respectively, accounting for only the 4% of the total cost, on average. The bootstrapping analysis showed that the mean QALY are 0.802 QALYs per life year with a standard deviation (SD) of 0.058 at 95% confidence interval (CI) (LCI: 0.693, UCI: 0.919), while the mean cost is 346.50€ with SD 0.049 at 95% CI (LCI: 235.42, UCI: 422.45). Conclusions: According to the results of the analysis, the control of fluoropyrimidine-related toxicity through the DPYD genotyping may yield an effective option for the quality and life expectancy of patients who suffer from colon cancer.

Postgraduate Studies Programme

Οικονομικά και Διοίκηση της Υγείας

Department

Σχολή Οικονομικών, Επιχειρηματικών και Διεθνών Σπουδών. Τμήμα Οικονομικής Επιστήμης

Number of pages

Language

Greek

URI

https://dione.lib.unipi.gr/xmlui/handle/unipi/17080
http://dx.doi.org/10.26267/unipi_dione/4503

Collections

Τμήμα Οικονομικής Επιστήμης

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Except where otherwise noted, this item's license is described as
Αναφορά Δημιουργού-Όχι Παράγωγα Έργα 3.0 Ελλάδα