Budgetary Impact of Pre-Therapeutic DPD Deficiency Screening in Fluoropyrimidine-Treated Cancer Patients in Algeria

OBJECTIVES: Fluoropyrimidines (FPs) are anti-cancer drugs widely used in oncology. Between 10 to 40% of patients undergoing FP treatment experience severe toxicity, which can lead to hospitalization and even death in 1% of cases. This toxicity is exacerbated by a deficiency in dihydropyrimidine dehydrogenase (DPD), a key enzyme which inactivates more than 80% of the 5-fluorouracil administered and is responsible for the conversion of uracil (U, natural substract) into dihydrouracil (UH₂). Pre-therapeutic screening for DPD deficiency, through uracilemia testing, is recommended by the European Medicines Agency and the French Health Authority. The UH₂/U ratio can also be used. The objective of this study is to determine the cost and budgetary impact of this screening in Algeria.

METHODS: Cost estimates for implementing the screening were conducted using two testing techniques: uracilemia by UPLC-DAD and the UH₂/U ratio by UPLC-MS/MS. A budget impact analysis (BIA) was conducted from the payer perspective over a 5-year horizon, including cancer patients treated with FP in an Oncology service. Costs associated with managing adverse effects and screening were evaluated. Two scenarios were examined: current practice without screening and a future scenario with screening.

RESULTS: Over a five-year period, 2,418 patients, representing 94.95% of the eligible population at the Cancer Center, receive fluoropyrimidine treatment. The implementation of screening in a single center costs €56,684.85 with UPLC-DAD and € 91,803.90 with UPLC-MS/MS. Compared to the current scenario without screening, early screening by UPLC-MS/MS and UPLC-DAD could generate savings over five years estimated at € 102,455.53 and € 52,115.86, respectively.

CONCLUSIONS: Screening for DPD deficiency, despite requiring initial investment, offers significant benefits by preventing severe complications and reducing costs associated with Fluoropyrimidine toxicity. Potential savings at a single center could support expanding screening on a larger scale, thereby improving the management of anticancer treatments in Algeria.