Evidence map›Paper›PMID 21344614›Full record

ArticlePediatric blood & cancer2011

A cost effectiveness analysis of thiopurine methyltransferase testing for guiding 6-mercaptopurine dosing in children with acute lymphoblastic leukemia.

Jennifer R Donnan, Wendy J Ungar, Maria Mathews, Rebecca L Hancock-Howard, Proton Rahman

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Pediatric blood & cancer, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 7 pooled it
4.4field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 7 syntheses or guidelines pooled it, 42 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. PreemptiveJournal of personalized medicine · 2023
    Article
  9. Article
  10. Article
  11. Article
  12. Utility-Based Multicriteria Model for Screening Patients under the COVID-19 Pandemic.Computational and mathematical methods in medicine · 2020
    Article
  13. Review
  14. Review
  15. Article
  16. Review
  17. Article
  18. Article
  19. Weight-based dosing in medication use: what should we know?Patient preference and adherence · 2016
    Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 1 country.

Jennifer R DonnanDepartment of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
Wendy J Ungar
Maria Mathews
Rebecca L Hancock-Howard
Proton Rahman
Memorial University of Newfoundland · CAHospital for Sick Children · CANewfoundland and Labrador Centre for Applied Health Research · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn increased understanding of the genetic basis of disease creates a demand for personalized medicine and more genetic testing for diagnosis and treatment. The objective was to assess the incremental cost-effectiveness per life-month gained of thiopurine methyltransferase (TPMT) genotyping to guide doses of 6-mercaptopurine (6-MP) in children with acute lymphoblastic leukemia (ALL) compared to enzymatic testing and standard weight-based dosing. PROCEDURE: A cost-effectiveness analysis was conducted from a health care system perspective comparing costs and consequences over 3 months. Decision analysis was used to evaluate the impact of TPMT tests on preventing myelosuppression and improving survival in ALL patients receiving 6-MP. Direct medical costs included laboratory tests, medications, physician services, pharmacy and inpatient care. Probabilities were derived from published evidence. Survival was measured in life-months. The robustness of the results to variable uncertainty was tested in one-way sensitivity analyses. Probabilistic sensitivity analysis examined the impact of parameter uncertainty and generated confidence intervals around point estimates.

resultsNeither of the testing interventions showed a benefit in survival compared to weight-based dosing. Both test strategies were more costly compared to weight-based dosing. Incremental costs per child (95% confidence interval) were $277 ($112, $442) and $298 ($392, $421) for the genotyping and phenotyping strategies, respectively, compared to weight-based dosing.

conclusionsThe present analysis suggests that screening for TPMT mutations using either genotype or enzymatic laboratory tests prior to the administration of 6-MP in pediatric ALL patients is not cost-effective.

Indexed as

Antimetabolites, AntineoplasticBone Marrow DiseasesChild, PreschoolClinical Enzyme TestsCost-Benefit AnalysisDecision TreesDrug Dosage CalculationsGenetic TestingGenotypeHumansMercaptopurineMethyltransferasesModels, EconometricOntarioPrecursor Cell Lymphoblastic Leukemia-LymphomaSensitivity and SpecificityAntimetabolites, AntineoplasticMercaptopurineMethyltransferasesthiopurine methyltransferase

Identifiers

PMID21344614
OpenAlexW2049491341

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.