Cost-effectiveness analysis of pretreatment screening for NUDT15 defective alleles.
Pharmacogenet Genomics
; 30(8): 175-183, 2020 10.
Article
in En
| MEDLINE
| ID: mdl-32433339
ABSTRACT
BACKGROUND:
Nucleotide triphosphate diphosphatase (NUDT15) genetic testing in addition to thiopurine methyl transferase (TPMT) is recommended to reduce the incidence of adverse severe myelotoxicity episodes induced by thiopurines.OBJECTIVE:
We assessed the cost-effectiveness ratio of combined screening for TMPT and NUDT15 defective alleles by genotyping or next-generation sequencing (NGS) using TPMT genotyping as the reference. Because of the genetic differences in thiopurine toxicity, we tested the screening strategies on individuals of Caucasian and Asian descent.METHODS:
A decision tree compared conventional TPMT genotyping with combined TPMT/NUDT15 genotyping or NGS using a Monte-Carlo microsimulation model of patients with inflammatory bowel disease. The main outcome was the incremental cost-effectiveness ratios (ICER) with effectiveness being one averted severe myelotoxicity requiring hospitalization.RESULTS:
The mean estimated cost of the TPMT genotyping for one year is twice in Asian compared with Caucasian patients (980 euro/patient versus 488 euro/patient), and the effectiveness of TPMT genotyping in Caucasian avoided 43 severe myelosuppressions per 10 000 patients over a year compared with 3.6 per 10 000 patients in Asian. Combined TPMT/NUDT15 genotyping compared with TPMT genotyping had an ICER of 7 491 281 euro per severe myelotoxicity averted in Caucasian, compared to 619 euro in Asian. The ICER of the NGS-based screening strategy is disproportionally high compared with genotyping, irrespective of ethnic descent.CONCLUSION:
With a low cost-effectiveness threshold, combined screening for NUDT15 and TPMT defective alleles is cost-effective compared to TMPT screening alone in patients of Asian descent, but is unrealistic from a cost-effectiveness point of view in Caucasians.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pyrophosphatases
/
Azathioprine
/
Bone Marrow Diseases
/
Inflammatory Bowel Diseases
/
Drug Hypersensitivity
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Genotyping Techniques
/
Methyltransferases
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Pharmacogenet Genomics
Journal subject:
FARMACOLOGIA
/
GENETICA MEDICA
Year:
2020
Document type:
Article
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA