Dihydropyrimidine Dehydrogenase (DPYD) Genetic Testing Before Fluoropyrimidine-Based Adjuvant Chemotherapy for Colorectal Cancer in Qatar: A Cost-Effective Approach
Author(s)
Dina Abushanab, PhD1, Rawan Alfroukh, BPharm2, Shaban Mohammed, MD3, Rania Abdellatif, PhD4, Anas Hamad, MSc, PhD3, Shereen ElAzzazy, BSc, MBA, PharmD, PhD5, Radja Badji, PhD4, Wadha Al-Muftah, PhD4, Said I. Ismail, PhD2, Kakil Rasul, MD3, Asma Al-Thani, PhD2, Moza Al Hail, BPharm3, Daoud Al-Badriyeh, PhD6.
1Pharmacy, Hamad Medical Corporation, Doha, Qatar, 2Qatar University, Doha, Qatar, 3Hamad Medical Corporation, Doha, Qatar, 4Qatar Foundation, Doha, Qatar, 5Hamad Medical Corporation, DOHA, Qatar, 6College of Pharmacy, Qatar University, Doha, Qatar.
1Pharmacy, Hamad Medical Corporation, Doha, Qatar, 2Qatar University, Doha, Qatar, 3Hamad Medical Corporation, Doha, Qatar, 4Qatar Foundation, Doha, Qatar, 5Hamad Medical Corporation, DOHA, Qatar, 6College of Pharmacy, Qatar University, Doha, Qatar.
OBJECTIVES: This study aims to evaluate the cost-effectiveness of dihydropyrimidine dehydrogenase (DPYD) genetic screening prior to adjuvant chemotherapy in colorectal cancer (CRC) patients in Qatar.
METHODS: A 6-month decision-tree model and a lifetime Markov model were constructed. The cost-effectiveness analysis compared two strategies: DPYD genetic screening and no screening prior to adjuvant chemotherapy in early-stage resectable CRC patients in Qatar. Clinical outcomes and utility values were extracted from published studies, while relevant costs were derived from Hamad Medical Corporation in Qatar. The analysis was conducted from the perspective of the Qatari healthcare provider, incorporating direct medical costs. The short-term outcome included the incremental cost-effectiveness ratio (ICER), defined as cost per success (survival without grade III/IV Adverse Drug Reactions) at 6 months. The long-term outcome was the ICER, defined as cost per Life-Years Gained (LYG) and cost per quality-adjusted life year (QALY) gained, with a 3% annual discount rate. Sensitivity analyses were conducted to explore the impact of key input parameters on the robustness of the model
RESULTS: In the short-term model, the average difference in 6-month survival without ADRs between screening arm and no screening arm was 0.1822. The long-term analysis showed that the DPYD genetic screening strategy, while more costly, provided better clinical outcomes than no screening. It resulted in an additional 185 LYG and 1,989 QALYs compared to 1,837 QALYs in the no screening group. The total costs for the screening strategy were QAR 52,162,683 (USD 14,328,442), versus QAR 45,438,084 (USD 12,451,338) for no screening. The ICER was QAR 36,436 (USD 12,067) per QALY.
CONCLUSIONS: DPYD genetic screening before fluoropyrimidine-based adjuvant chemotherapy in CRC patients is a cost-effective strategy in Qatar, potentially reducing severe ADRs and improving patient outcomes. Implementing this screening aligns with precision medicine goals and can guide personalized treatment strategies. Further research is needed to refine patient selection criteria.
METHODS: A 6-month decision-tree model and a lifetime Markov model were constructed. The cost-effectiveness analysis compared two strategies: DPYD genetic screening and no screening prior to adjuvant chemotherapy in early-stage resectable CRC patients in Qatar. Clinical outcomes and utility values were extracted from published studies, while relevant costs were derived from Hamad Medical Corporation in Qatar. The analysis was conducted from the perspective of the Qatari healthcare provider, incorporating direct medical costs. The short-term outcome included the incremental cost-effectiveness ratio (ICER), defined as cost per success (survival without grade III/IV Adverse Drug Reactions) at 6 months. The long-term outcome was the ICER, defined as cost per Life-Years Gained (LYG) and cost per quality-adjusted life year (QALY) gained, with a 3% annual discount rate. Sensitivity analyses were conducted to explore the impact of key input parameters on the robustness of the model
RESULTS: In the short-term model, the average difference in 6-month survival without ADRs between screening arm and no screening arm was 0.1822. The long-term analysis showed that the DPYD genetic screening strategy, while more costly, provided better clinical outcomes than no screening. It resulted in an additional 185 LYG and 1,989 QALYs compared to 1,837 QALYs in the no screening group. The total costs for the screening strategy were QAR 52,162,683 (USD 14,328,442), versus QAR 45,438,084 (USD 12,451,338) for no screening. The ICER was QAR 36,436 (USD 12,067) per QALY.
CONCLUSIONS: DPYD genetic screening before fluoropyrimidine-based adjuvant chemotherapy in CRC patients is a cost-effective strategy in Qatar, potentially reducing severe ADRs and improving patient outcomes. Implementing this screening aligns with precision medicine goals and can guide personalized treatment strategies. Further research is needed to refine patient selection criteria.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE330
Topic
Clinical Outcomes, Economic Evaluation, Organizational Practices
Disease
Oncology