Title
Cost-effectiveness of pharmacogenomics in clinical practice: A case study of thiopurine methyltransferase genotyping in acute lymphoblastic leukemia in Europe
Author
van den Akker-van Marle, M.E.
Gurwitz, D.
Detmar, S.B.
Enzing, C.M.
Hopkins, M.M.
Gutierrez De Mesa, E.
Ibarreta, D.
TNO Kwaliteit van Leven
Publication year
2006
Abstract
Only a few studies have addressed the cost-effectiveness of pharmacogenetics interventions in healthcare. Lack of health economics data on aspects of pharmacogenetics is perceived as one of the barriers hindering its implementation for improving drug safety. Thus, a recent Institute for Prospective Technological Studies (IPTS) study, entitled 'Pharmacogenetics and pharmacogenomics: state-of-the-art and potential socio-economic impact in the EU' included an explorative cost-effectiveness review for a pharmacogenetic treatment strategy compared with traditional medical practice. The selected case study examined the cost-effectiveness of thiopurine methyltransferase (TMPT) genotyping prior to thiopurine treatment in children with acute lymphoblastic leukemia (ALL). Information for the cost-effectiveness model parameters was collected from literature surveys and interviews with experts from four European countries (Germany, Ireland, the Netherlands and the UK). The model has established that TPMT testing in ALL patients has a favorable cost-effectiveness ratio. This conclusion was based on parameters collected for TPMT genotyping costs, estimates for frequency of TMPT deficiency, rates of thiopurine-mediated myelosuppression in TPMT-deficient individuals, and myelosuppression-related hospitalization costs in each of the four countries studied. The mean calculated cost per life-year gained by TPMT genotyping in ALL patients in the four study countries was €2100 (or €4800 after 3% discount) based on genotyping costs of €150 per patient. Cost per life-year gained is expected to further improve following the introduction of the wider use of TMPT genotyping and the availability of lower cost genotyping methods. Our analysis indicates that TPMT genotyping should be seriously considered as an integral part of healthcare prior to the initiation of therapy with thiopurine drugs. © 2006 Future Medicine Ltd. Chemicals / CAS: azathioprine, 446-86-6; mercaptopurine, 31441-78-8, 50-44-2, 6112-76-1; thiopurine methyltransferase, 67339-09-7; Antineoplastic Agents; Methyltransferases, EC 2.1.1.-; thiopurine methyltransferase, EC 2.1.1.67
Subject
Health
Antineoplastic Agents
Cost-Benefit Analysis
Europe
Genotype
Humans
Leukemia, Lymphocytic, Acute
Methyltransferases
Models, Economic
Pharmacogenetics
6-mercaptopurine
Acute lymphoblastic leukemia
Adverse drug reactions
Cost-effectiveness analysis
Drug-metabolizing enzymes
Germany
Ireland
Netherlands
Pharmacogenetics
Thiopurine drugs
Thiopurine methyltransferase (TMPT)
United Kingdom
Azathioprine
Drug metabolizing enzyme
Mercaptopurine
Thiopurine methyltransferase
Acute lymphoblastic leukemia
Anorexia
Blood toxicity
Bone marrow suppression
Calculation
Case study
Clinical practice
Cytopenia
Diarrhea
Drug dose regimen
Drug fatality
Drug hypersensitivity
Enteritis
Enzyme activity
Enzyme deficiency
Europe
Graft rejection
Health care quality
Health survey
Heterozygosity
Homozygosity
Hospital cost
Infection
Interview
Leukopenia
Nausea
Pancreatitis
Phenotype
Polymerase chain reaction
Sensitivity and specificity
Sepsis
United Kingdom
Vomiting
Wild type
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http://resolver.tudelft.nl/uuid:071d89e7-8e83-4478-8318-9b15ecd7a810
DOI
https://doi.org/10.2217/14622416.7.5.783
TNO identifier
239413
ISSN
1462-2416
Source
Pharmacogenomics, 7 (5), 783-792
Document type
article