Cost-effectiveness of UGT1A1 genotyping in second-line, high-dose, once every 3 weeks irinotecan monotherapy treatment of colorectal cancer.
OBJECTIVE
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.


CONCLUSIONS
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.
Obradovic
Marko
M
University of Ljubljana, Faculty of Pharmacy, Askerceva 7, 1000 Ljubljana, Slovenia. marko.obradovic@ffa.uni-lj.si
Mrhar
Ales
A
Kos
Mitja
M
D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005838:Genotype; D014453:Glucuronosyltransferase / Q000191:economics* / Q000235:genetics*; D006801:Humans; D000077146:Irinotecan; D000099148:UGT1A1 Enzyme
D002166:Camptothecin; D014453:Glucuronosyltransferase; D000077146:Irinotecan; D000099148:UGT1A1 Enzyme