Cost––effectiveness of UGT1A1 genotyping in second-line, high-dose, once every 3 weeks irinotecan monotherapy treatment of colorectal cancer. (May 2008)

• Record Type: Journal Article
• Authors: Obradovic, Marko; Mrhar, Ales; Kos, Mitja
• Is Part Of: Pharmacogenomics. Volume 9:Number 5(2008)
• Page Start: 539
• Page End: 549
• Publication Date: 2008-05
• Subjects: colorectal cancer -- cost––effectiveness -- decision analysis -- irinotecan -- UGT1A1 genotyping; Pharmacogenomics -- Periodicals; 615.1
• DOI: 10.2217/14622416.9.5.539
• Languages: English
• ISSNs: 1462-2416

Abstract

Aim: The aim of the present study was to evaluate the cost––effectiveness of UGT1A1 genotyping in second-line, high-dose, once every 3 weeks irinotecan monotherapy treatment of colorectal cancer.Methods: Standard therapy was compared with alternative strategies based on UGT1A1 genotyping from the US healthcare payer perspective. Two alternative strategies (dose reduction and prophylactic use of G-CSF with prior genotyping) and standard therapy were evaluated in a decision analysis, whereas alternative regimens were considered in discussion. The effectiveness outcome was severe neutropenia occurrence and number of life-years gained.Results & Conclusion: Genotyping in combination with a subsequent reduction of initial irinotecan dose for UGT1A1 7/7 genotype patients was cost-saving for the population of African and Caucasian origin. By contrast, UGT1A1 genotyping was not cost effective for the population of Asian ancestry. Furthermore, the prophylactic use of G-CSFs in UGT1A1 7/7 genotype patients was not cost effective in any population group. Finally, the application of a 3-weekly high-dose treatment regimen with a 20% reduced dosage compared with the low-dose weekly irinotecan regimen in patients with UGT1A1 7/7 genotype was less expensive and is more convenient for the patient.