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Published online: 26 September 2019
© Springer Nature Switzerland AG 2019
Abstract
Background A CYP2D6 gene polymorphism is related to the effect of tamoxifen treatment in patient with estrogen-receptor positive (ER) positive breast cancer and CYP2D6·10 T/T can lead to a poor prognosis in Asian patients. Although one-off pharmacogenetic testing may optimize adjuvant endocrine therapy, testing prior to tamoxifen initiation incurs additional costs.
Aim We conducted a study to assess the cost-effectiveness of CYP2D6·10 pharmacogenetic testing to guide the adjuvant endocrine therapy compared with tamoxifen without CYP2D6·10 testing in China.
Methods A semi-Markov model was developed to evaluate costs and health outcomes represented as quality adjusted life year (QALY) gained. Input data were obtained from the public literature. The results were expressed as incremental cost per QALY gained. A one-way deterministic sensitivity analysis explored the impact of uncertainty in the model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.
Results In the base-case analysis, in the CYP2D6·10 testing and alternative adjuvant endocrine therapy group, the incremental total cost was US$17,966.95 and the incremental QALY was 3.582. Thus, the incremental cost-effectiveness ratio was US$5015.693 per QALY gained. Compared with a willingness-to-pay threshold of US$26,508/QALY in China, the CYP2D6·10 testing is the dominant strategy in postmenopausal women with ER-positive breast cancer in China, and the increased cost of genetic testing was completely worthwhile. The sensitivity analyses showed that the model we built was quite stable.
Conclusion From the perspective of the Chinese healthcare system, CYP2D6·10 pharmacogenetic testing was cost effective for postmenopausal women with ER-positive early breast cancer.
1Introduction
Pharmacogenetics (PGx) is broadly used for clinical testing of genetic variations that contribute to differing responses to drugs [1]. There is a strong desire to improve the clinical outcomes of pharmacotherapy, including efficacy and safety [2]. The Mayo Clinic observed that among the 1013 participants tested for five well-characterized PGx genes, the result showed that 99% of this study population has at least one actionable PGx variant, and the variant gene(s) could guide patients to use drugs rationally [3]. However, pharmacogenomics is subject to the techniques of detection, costs, and health-care policies, which affect its clinical implementation [2]. Therefore, it is important that the cost effectiveness of novel PGx-guided treatment...