Genotype-Guided Thiopurine Dosing Does not Lead to Additional Costs in Patients With Inflammatory Bowel Disease.

Autor: Sluiter, Reinier L, Marrewijk, Corine Van, Jong, Dirk De, Scheffer, Hans, Guchelaar, Henk-Jan, Derijks, Luc, Wong, Dennis R, Hooymans, Piet, Vermeulen, Sita H, Verbeek, André L M, Franke, Barbara, Wilt, Gert Jan Van der, Kievit, Wietske, Coenen, Marieke J H
Zdroj: Journal of Crohn's & Colitis; Jul2019, Vol. 13 Issue 7, p838-845, 8p
Abstrakt: Background and Aims Decreased thiopurine S -methyltransferase [TPMT] enzyme activity increases the risk of haematological adverse drug reactions [ADRs] in patients treated with thiopurines. Clinical studies have shown that in patients with inflammatory bowel disease [IBD], pharmacogenetic TPMT -guided thiopurine treatment reduces this risk of ADRs. The aim of this study was to investigate whether this intervention impacts on healthcare costs and/or quality of life. Methods An a priori defined cost-effectiveness analysis was conducted in the Thiopurine response Optimization by Pharmacogenetic testing in Inflammatory bowel disease Clinics [TOPIC] trial, a randomized controlled trial performed in 30 Dutch hospitals. Patients diagnosed with IBD [age ≥18 years] were randomly assigned to the intervention [i.e. pre-treatment genotyping] or control group. Total costs in terms of volumes of care, and effects in quality-adjusted life years [QALYs], based on EuroQol-5D3L utility scores, were measured for 20 weeks. Mean incremental cost savings and QALYs with confidence intervals were calculated using non-parametric bootstrapping with 1000 replications. Results The intervention group consisted of 381 patients and the control group 347 patients. The mean incremental cost savings were €52 per patient [95% percentiles −682, 569]. Mean incremental QALYs were 0.001 [95% percentiles −0.009, 0.010]. Sensitivity analysis showed that the results were robust for potential change in costs of screening, costs of biologicals and costs associated with productivity loss. Conclusions Genotype-guided thiopurine treatment in IBD patients reduced the risk of ADRs among patients carrying a TPMT variant, without increasing overall healthcare costs and resulting in comparable quality of life, as compared to standard treatment. [ABSTRACT FROM AUTHOR]
Databáze: Supplemental Index
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje