Cost effectiveness of pharmacogenetic testing for UGT1A1 before irinotecan administration for metastatic colorectal cancer

摘要

PurposeTo examine the cost effectiveness of using a pharmacogenetic test for UGT1A1*28 variant homozygosity before administering irinotecan in metastatic colorectal cancer patients. Patients and Methods: Decision-analytic model from Medicare payer perspective followed hypothetical patients treated with FOLFIRI (5-fluorouracil/leucovorin with irinotecan). Under usual care, patients received a full dose of irinotecan. With genetic testing, irinotecan dosage was reduced 25% in homozygotes with the UGT1A1*28 variant allele. Test performance, chemotherapy toxicity, and quality-of-life weights were from clinical literature and product labels. Costs were from 2007 Medicare fee schedules. Chemotherapy efficacy after dose reduction, adverse event risk, and other parameters were varied in one-way and probabilistic sensitivity analyses. We calculated the value of investing in further studies of chemotherapy efficacy following homozygote dose reductions.