title: Understanding chemotherapy treatment pathways of advanced colorectal cancer patients to inform an economic evaluation in the United Kingdom.
abstract: BACKGROUND
  Accurate description of current practice within advanced colorectal cancer (CRC) specialties were needed to inform an economic evaluation of the UGT1A1 pharmacogenetic test for irinotecan in the United Kingdom.
  
  
  METHODS
  The study was based on a literature review and elicitation of expert opinion. The expert panel comprised 44 consultant oncologists in NHS Hospital Trusts across England.
  
  
  RESULTS
  Ten first-line, 10 second-line and 12 third-line chemotherapy regimens were reported, reflecting wide variations in treatment pathways. Predominant pathways emerged with: first-line treatment with oxaliplatin-based regimens, second-line treatment with irinotecan-based regimens and third-line treatment with mitomycin-based regimens. Experts estimated the frequency of febrile neutropaenia 8.4% (95% CI: 6.7-10.0), septic neutropaenia 4.7% (95% CI: 3.4-6.0) and severe diarrhoea 13.1% (95% CI: 10.8-15.5). Approaches for the clinical management of neutropaenia within the NHS were described.
  
  
  CONCLUSIONS
  This study identified wide variations in the clinical management of advanced CRC patients. Descriptions of current treatment pathways are necessary for economic evaluations. Variations in clinical practice must be reflected in the model to ensure the findings from an economic evaluation of UGT1A1 testing are sufficient to inform policy regarding the cost-effective use of NHS resources.
authors.affiliation: Health Sciences - Economics, School of Community Based Medicine, The University of Manchester, 1st Floor, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: F H
authors.initials: FH
authors.lastname: Shabaruddin
authors.forename: R A
authors.initials: RA
authors.lastname: Elliott
authors.forename: J W
authors.initials: JW
authors.lastname: Valle
authors.forename: W G
authors.initials: WG
authors.lastname: Newman
authors.forename: K
authors.initials: K
authors.lastname: Payne
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D002166:Camptothecin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000201:enzymology / Q000473:pathology; D003967:Diarrhea / Q000139:chemically induced; D005472:Fluorouracil / Q000627:therapeutic use; D014453:Glucuronosyltransferase / Q000032:analysis* / Q000235:genetics; D006306:Health Surveys; D006801:Humans; D000077146:Irinotecan; D016685:Mitomycin / Q000009:adverse effects / Q000627:therapeutic use; D009503:Neutropenia / Q000139:chemically induced* / Q000145:classification; D009944:Organoplatinum Compounds / Q000009:adverse effects / Q000627:therapeutic use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013222:State Medicine; D006113:United Kingdom; D000099148:UGT1A1 Enzyme
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D002166:Camptothecin; D005472:Fluorouracil; D014453:Glucuronosyltransferase; D000077146:Irinotecan; D016685:Mitomycin; D009944:Organoplatinum Compounds; D011725:Pyridines; D000099148:UGT1A1 Enzyme; C431073:oxiplatin