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A cost effectiveness analysis of thiopurine methyltransferase testing for guiding 6‐mercaptopurine dosing in children with acute lymphoblastic leukemia
Author(s) -
Donnan Jennifer R.,
Ungar Wendy J.,
Mathews Maria,
HancockHoward Rebecca L.,
Rahman Proton
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22936
Subject(s) - medicine , thiopurine methyltransferase , dosing , mercaptopurine , confidence interval , quality adjusted life year , intensive care medicine , cost effectiveness , oncology , disease , azathioprine , risk analysis (engineering)
Background An increased understanding of the genetic basis of disease creates a demand for personalized medicine and more genetic testing for diagnosis and treatment. The objective was to assess the incremental cost‐effectiveness per life‐month gained of thiopurine methyltransferase (TPMT) genotyping to guide doses of 6‐mercaptopurine (6‐MP) in children with acute lymphoblastic leukemia (ALL) compared to enzymatic testing and standard weight‐based dosing. Procedure A cost‐effectiveness analysis was conducted from a health care system perspective comparing costs and consequences over 3 months. Decision analysis was used to evaluate the impact of TPMT tests on preventing myelosuppression and improving survival in ALL patients receiving 6‐MP. Direct medical costs included laboratory tests, medications, physician services, pharmacy and inpatient care. Probabilities were derived from published evidence. Survival was measured in life‐months. The robustness of the results to variable uncertainty was tested in one‐way sensitivity analyses. Probabilistic sensitivity analysis examined the impact of parameter uncertainty and generated confidence intervals around point estimates. Results Neither of the testing interventions showed a benefit in survival compared to weight‐based dosing. Both test strategies were more costly compared to weight‐based dosing. Incremental costs per child (95% confidence interval) were $277 ($112, $442) and $298 ($392, $421) for the genotyping and phenotyping strategies, respectively, compared to weight‐based dosing. Conclusions The present analysis suggests that screening for TPMT mutations using either genotype or enzymatic laboratory tests prior to the administration of 6‐MP in pediatric ALL patients is not cost‐effective. Pediatr Blood Cancer 2011; 57: 231–239. © 2011 Wiley‐Liss, Inc.