Budget Impact Analysis of TPMT and NUDT15 Pharmacogenomic Testing for 6-Mercaptopurine in Pediatric Acute Lymphocytic Leukemia Patients

Speaker(s)

Fuerte B1, Burgos EM2, Cao V2, Nguyen J3, Maggo S3, Bhojwani D3, Rushing T3, Gong C4
1Alfred E. Mann School of Pharmacy, University of Southern California, ARCADIA, CA, USA, 2Alfred E. Mann School of Pharmacy, University of Southern California, Los Angeles, CA, USA, 3Children’s Hospital Los Angeles, Los Angeles, CA, USA, 4Children's Hospital Los Angeles, South Pasadena, CA, USA

Presentation Documents

OBJECTIVES: Pharmacogenomic testing identifies gene polymorphisms impacting drug metabolism, aiding in optimizing treatment efficacy and minimizing toxicity, thus potentially reducing healthcare utilization. 6-mercaptopurine metabolism is affected by thiopurine methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15) polymorphisms. We sought to estimate the budget impact of preemptive pharmacogenomic testing for these genes in pediatric acute lymphoblastic leukemia (ALL) patients from an institutional perspective. This is in response to heightened costs associated with supplemental care for adverse events, like severe myelosuppression, resulting from traditional dosing of 6-mercaptopurine.

METHODS: A Markov Model was constructed to model the first cycle of the maintenance phase of chemotherapy for pediatric ALL patients transitioning between one of three health states: stable, moderately myelosuppressed, and severely myelosuppressed over 16 weeks, with each health state’s associated costs derived from the literature. The patient’s likelihood to experience moderate or severe myelosuppression based on metabolism expresser type was calculated from the literature and applied on a weekly basis, and the marginal budget impact of preemptive pharmacogenomic testing vs. no pharmacogenomic testing was calculated. One-way sensitivity analysis was conducted to assess parameter influence on results.

RESULTS: Preemptive pharmacogenomic testing of TPMT and NUDT15 provided savings of up to $26,026 per patient during the maintenance phase. In the sensitivity analysis, the cost of outpatient management of moderate myelosuppression had the greatest impact on the budget impact, resulting in cost savings ranging from $8,592 to $30,129 when the minimum and maximum costs of management were used in the model.

CONCLUSIONS: Preemptive pharmacogenomic testing for TPMT and NUDT15 polymorphisms prior to initiation of maintenance therapy for pediatric ALL patients yielded considerable cost savings, and should be routinely considered prior to initiation of thiopurine therapy.

Code

EE320

Topic

Economic Evaluation

Topic Subcategory

Budget Impact Analysis, Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Oncology, Pediatrics