A CYP2D6 gene polymorphism is related to the effect of tamoxifen treatment in patient with estrogen-receptor positive (ER) positive breast cancer and CYP2D6*10 T/T can lead to a poor prognosis in Asian patients. Although one-off pharmacogenetic testing may optimize adjuvant endocrine therapy, testing prior to tamoxifen initiation incurs additional costs.
We conducted a study to assess the cost-effectiveness of CYP2D6*10 pharmacogenetic testing to guide the adjuvant endocrine therapy compared with tamoxifen without CYP2D6*10 testing in China.
A semi-Markov model was developed to evaluate costs and health outcomes represented as quality adjusted life year (QALY) gained. Input data were obtained from the public literature. The results were expressed as incremental cost per QALY gained. A one-way deterministic sensitivity analysis explored the impact of uncertainty in the model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.
In the base-case analysis, in the CYP2D6*10 testing and alternative adjuvant endocrine therapy group, the incremental total cost was US$17,966.95 and the incremental QALY was 3.582. Thus, the incremental cost-effectiveness ratio was US$5015.693 per QALY gained. Compared with a willingness-to-pay threshold of US$26,508/QALY in China, the CYP2D6*10 testing is the dominant strategy in postmenopausal women with ER-positive breast cancer in China, and the increased cost of genetic testing was completely worthwhile. The sensitivity analyses showed that the model we built was quite stable.
From the perspective of the Chinese healthcare system, CYP2D6*10 pharmacogenetic testing was cost effective for postmenopausal women with ER-positive early breast cancer.
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This study was supported in part by grants from the Natural Science Foundation of Fujian (No. 2019J01177), high-level hospital foster grants from Fujian Provincial Hospital (No. 2019HSJJ06), Fujian Science and Technology Innovation Joint Fund Project (No. 2017Y9067), Startup Fund for scientific research, Fujian Medical University (No. 2016QH106 and No. 2016QH107), Youth Scientific Research Project of Fujian Provincial Health Department (No. 2016-1-8) and the Science and Technology, Department of Fujian Province (No. 2018R0041) of the People’s Republic of China.
Conflict of interest
The authors declare that they have no conflicts of interest to disclose regarding this study. All the authors were substantially involved in the study and/or preparation of the manuscript. All authors declare no support from any organization for the submitted work; All authors declare no other relationships or activities that could appear to have influenced the submitted work. The present study was not supported by a pharmaceutical company, and no persons or entity had input into the design or analysis of the cost-effective analysis besides the listed authors.
This article does not contain any studies with human participants performed by any of the authors.
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Wei, X., Sun, H., Zhuang, J. et al. Cost-effectiveness Analysis of CYP2D6*10 Pharmacogenetic Testing to Guide the Adjuvant Endocrine Therapy for Postmenopausal Women with Estrogen Receptor Positive Early Breast Cancer in China. Clin Drug Investig 40, 25–32 (2020) doi:10.1007/s40261-019-00842-0