Medico-Economic Benefit of Dihydropyrimidine Dehydrogenase Screening in the Colorectal Cancer Treatment Using Fluoropyrimidines in Algeria

OBJECTIVES: Screening for dihydropyrimidine dehydrogenase (DPD) is an essential step in oncology, enabling the identification of patients at risk of severe toxicity to fluoropyrimidine-based drugs. This study aims to assess the medico-economic impact of DPD screening in colorectal cancer (CRC) patients in Algeria.

METHODS: The method was based on the retrospective collection of patient data admitted to the oncology department between January 2021 and December 2023. The data concerned therapeutic management protocols, and the costs associated with this management according to two scenarios, one without systematic DPD screening and the other after the introduction of screening. A pharmacoeconomic model was used to estimate national expenditure on CRC management over a five-year time horizon.

RESULTS: The study involved 403 CRC patients, 137 of whom suffered serious side effects from treatment. The cost of managing CRC (without screening) was estimated at nearly €1.40 million (2023), compared with €1.41 million (with screening), with an average annual cost per patient of €3,488. Versus 1.41 M€ (with screening), with an average annual cost per patient of 3488€.On a national scale, the cost of managing patients (without screening) had risen from 80.40 M€ (2023) to over 145.84 M€ (2028). Considering the deficit rate (15%), expenditure would be over 80.14 M€ in 2023 and over 145.38 M€ in 2028.Despite these initial costs, screening would save over 254,000 € (2023) and over 461,000 € (2028). These savings are explained by the reduction in serious side effects and the improvement in patients' quality of life.

CONCLUSIONS: The cost of treating colorectal cancer with fluoropyrimidines in Algeria represents a major economic burden. These expenses continue to rise each year, taking into account the adverse effects induced in patients who are not screened. DPD screening remains essential to determine DPD status, thereby reducing the side effects associated with this deficiency and mitigating the associated costs.