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NUDT15 genetic testing-guided 6-mercaptopurine dosing in children with ALL likely to be cost-saving in China
XiaoXia Wei1, Jing Zhuang2, Na Li3
1Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, No. 134, Gulou District, Fuzhou, Fujian, 350000, People's Republic of China.
Insights
NUDT15 genetic testing for initial 6-mercaptopurine (6-MP) dosing in pediatric acute lymphoblastic leukemia (ALL) is cost-effective in China. This approach reduces costs and prevents severe leukopenia, improving patient outcomes.
Area of Science:
- Pharmacogenomics
- Pediatric Oncology
- Health Economics
Background:
- Acute lymphoblastic leukemia (ALL) treatment often involves 6-mercaptopurine (6-MP).
- Genetic variations, such as in NUDT15, can affect 6-MP metabolism and toxicity.
- Standard dosing may lead to suboptimal outcomes and increased healthcare costs.
Purpose of the Study:
- To evaluate the cost-effectiveness of NUDT15 genetic testing-guided 6-MP dosing in pediatric ALL patients in China.
- To compare the economic impact and clinical benefits of pharmacogenomic-guided dosing versus standard dosing.
Main Methods:
- A decision tree model was employed to assess cost per Quality-Adjusted Life-Year (QALY) gained and cost per case of severe leukopenia avoided.
- Public clinical data from China was utilized for the economic evaluation.
- Sensitivity analyses (one-way and probabilistic) were conducted to assess the robustness of the findings.
Main Results:
- NUDT15 genetic testing-guided 6-MP dosing resulted in a cost reduction of $518.61 per patient.
- This approach prevented 0.221 cases of Grade III-IV leukopenia per patient.
- An increase of 0.00136 QALY per patient was observed, indicating improved health outcomes.
Conclusions:
- NUDT15 genetic testing prior to initiating 6-MP in pediatric ALL patients in China is a cost-effective strategy.
- Pharmacogenomic-guided dosing is economically advantageous and clinically beneficial compared to standard dosing.
- This approach supports personalized medicine in pediatric oncology.
Objective:
The cost-effectiveness of NUDT15 genetic testing-guided initial 6-mercaptopurine (6-MP) dosing in children with acute lymphoblastic leukemia (ALL) was evaluated.
Methods:
A decision tree model was used to evaluate the cost to China's medical system per quality-adjusted life-year (QALY) gained and cost per case of severe leukopenia avoided of NUDT15 genetic testing using public clinical data.
Results:
Genetic testing-guided initial 6-MP dosing reduced overall costs by $518.61, and prevented 0.221 cases of Grade III-IV leukopenia and increased QALY by 0.00136 per patient. Results were robust in one-way analyses and probabilistic sensitivity analyses.
Conclusion:
NUDT15 genetic testing prior to the initial administration of 6-MP in pediatric ALL patients in China is less expensive than standard dosing without genetic testing.