OBJECTIVES : CYP2D6*10 polymorphisms influence the effectivenss of tamoxifen(TAM) in patients with breast cancer in Asia. Evidence from clinical trials suggests that toremifene(TOR), rather than TAM, might be a better option for the adjuvant endocrine therapy in CYP2D6*10T/T genotype breast cancer patients in China.However, it is lack of economic evaluation based on CYP2D6*10 genetic testing in China.A cost-effectiveness analysis was performed to determine the cost-effectiveness of CYP2D6*10 genetic testing for the management of Chinese women with hormone receptor-positive breast cancer treated with TAM.

METHODS : A Markov model was established based on clinical research data and medical costs in China.The main outputs of the model included costs and quality-adjusted life year (QALY) which were used to determine the incremental cost-effectiveness ratio (ICER).Willingness-to-pay threshold was set at $26,508/QALY (3×domestic GDP per capita, US$ 8,836 in 2017,in China).Robustness of the model was addressed in one-way analyses and probabilistic sensitivity analysis．

RESULTS : The cost of strategies of TAM, TOR without genotyping and the strategy base on CYP2D6*10 genotype were $14,382.79991, $14,744.68699, and $14,505.12258 respectively; their utilities are 1.88815, 2.24358 , and 2.26207 QALYs. The ICER of the CYP2D6*10 testing and TOR were $327.13184 and $-12957.44746/QALY, respectively.The ICER of the strategy of CYP2D6*10 genetic testing was lower than 1×domestic GDP per capita. Compared with that strategy of TAM ,the increased genetic testing cost was completely worthwhile with remarkable cost-effective advantages.

CONCLUSIONS : The analysis indicated that CYP2D6*10 pharmacogenetic-guided TAM can be a cost-effective strategy in the Chinese patients with hormone receptor-positive breast cancer.