ArticleClinical colorectal cancer2022
Cost-effectiveness of DPYD Genotyping Prior to Fluoropyrimidine-based Adjuvant Chemotherapy for Colon Cancer.
Article in Clinical colorectal cancer, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- DPYD genetic polymorphisms in non-European patients with severe fluoropyrimidine-related toxicity: a systematic review.British journal of cancer · 2024Pooled it
- Pharmacogenetic-guided dosing for fluoropyrimidine (DPYD) and irinotecan (UGT1A1*28) chemotherapies for patients with cancer (PACIFIC-PGx): A multicenter clinical trial.Clinical and translational science · 2024Trial
- Cost-effectiveness of DPYD genotyping prior to capecitabine administration for metastatic breast cancer.Breast cancer research and treatment · 2026Article
- Cost-Effectiveness of Pre-emptive DPYD Genotyping Compared to Standard of Care Among Patients Receiving Fluoropyrimidine-Based Anti-cancer Treatment in Australia.Clinical drug investigation · 2025Article
- Optimizing fluoropyrimidine therapy through dihydropyrimidine dehydrogenase polymorphism testing.World journal of gastrointestinal oncology · 2025Article
- A Guide for Implementing DPYD Genotyping for Systemic Fluoropyrimidines into Clinical Practice.Clinical pharmacology and therapeutics · 2025Review
- Dihydropyrimidine Dehydrogenase Deficiency (DPYD) Genotyping-Guided Fluoropyrimidine-Based Adjuvant Chemotherapy for Breast Cancer. A Cost-Effectiveness Analysis.Clinical drug investigation · 2025Article
- Balance of care activity after EMA recommendation forFrontiers in pharmacology · 2025Article
- Single nucleotide polymorphisms: impact on susceptibility to chemotherapy in patients with colorectal cancer.Future science OA · 2024Article
- Strategies for DPYD testing prior to fluoropyrimidine chemotherapy in the US.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Article
- Capecitabine-induced severe adverse events-therapeutic drug monitoring andBMJ case reports · 2024Article
- Immunotherapy-induced colitis in metastatic colorectal cancer: a systematic review and meta-analysis.Proceedings (Baylor University. Medical Center) · 2024Article
- Article
- Pharmacogenomics in practice: a review and implementation guide.Frontiers in pharmacology · 2023Review
- Pharmacogenomic-guided dosing of fluoropyrimidines beyondFrontiers in pharmacology · 2023Review
- The Implementation of Pharmacogenetics in the United Kingdom.Handbook of experimental pharmacology · 2023Article
- Implementing pharmacogenetic testing in fluoropyrimidine-treated cancer patients:Frontiers in pharmacology · 2023Article
- Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist's Perspective.Cancer control : journal of the Moffitt Cancer CenterReview
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAdjuvant fluoropyrimidine-based chemotherapy substantially reduces recurrence and mortality after resection of stage 3 colon cancer. While standard doses of 5-fluorouracil and capecitabine are safe for most patients, the risk of severe toxicity is increased for the approximately 6% of patients with dihydropyimidine dehydrogenase (DPD) deficiency caused by pathogenic DPYD gene variants. Pre-treatment screening for pathogenic DPYD gene variants reduces severe toxicity but has not been widely adopted in the United States.
methodsWe conducted a cost-effectiveness analysis of DPYD genotyping prior to fluoropyrimidine-based adjuvant chemotherapy for stage 3 colon cancer, covering the c.1129-5923C>G (HapB3), c.1679T>G (*13), c.1905+1G>A (*2A), and c.2846A>T gene variants. We used a Markov model with a 5-year horizon, taking a United States healthcare perspective. Simulated patients with pathogenic DPYD gene variants received reduced-dose fluoropyrimidine chemotherapy. The primary outcome was the incremental cost-effectiveness ratio (ICER) for DPYD genotyping.
resultsCompared with no screening for DPD deficiency, DPYD genotyping increased per-patient costs by $78 and improved survival by 0.0038 quality-adjusted life years (QALYs), leading to an ICER of $20,506/QALY. In 1-way sensitivity analyses, The ICER exceeded $50,000 per QALY when the cost of the DPYD genotyping assay was greater than $286. In probabilistic sensitivity analysis using a willingness-to-pay threshold of $50,000/QALY DPYD genotyping was preferred to no screening in 96.2% of iterations.
conclusionAmong patients receiving adjuvant chemotherapy for stage 3 colon cancer, screening for DPD deficiency with DPYD genotyping is a cost-effective strategy for preventing infrequent but severe and sometimes fatal toxicities of fluoropyrimidine chemotherapy.
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