Cost-effectiveness of DPYD genotyping prior to fluoropyrimidine-based treatment for colorectal cancer in Wales.

Dihydropyrimidine dehydrogenase deficiency (DPYD) — toxic fluorouracil accumulation

This Welsh pharmacoeconomic analysis evaluates the cost-effectiveness of DPYD genotyping before fluoropyrimidine-based treatment for colorectal cancer, in the context of UK regulatory guidance. The decision-analytic model demonstrates that screening is cost-saving, generates more QALYs, and reduces serious adverse drug reactions compared to standard prescribing without genotyping. An incremental net health benefit of 0.0118 QALYs is estimated (probability of cost-effectiveness: 0.96) for a five-variant panel. Adding variant c.557A>G to the standard panel further increases benefit, with implications for ethnically diverse populations.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

This study reinforces the pharmacoeconomic case for systematic DPYD genotyping, already recommended by the MHRA and EMA. The finding that screening is cost-saving — not merely cost-effective — is a decisive argument for health payers. The signal on additional variants beyond the standard panel advocates for expanded testing beyond the four classic DPWG variants, particularly in non-European populations.

Clinical impact: 3/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 0/1 · Journal quality: 1/1 → Total: 7/10