OBJECTIVES: Genetically-guided dosing of anti-cancer agents for mCRC presents the opportunity to improve patient outcomes and reduce direct patient costs, but the impact of this approach from the perspective of a health care system is uncertain. This project examines the budgetary impact of DPYD and UGT1A1 guided dosing for patients receiving FOLFIRI+bev for mCRC.

METHODS: We conducted a budget impact analysis following the recommendations of the joint ISPOR-SMDM taskforce. This analysis was conducted from the perspective of a US health care system, with a time horizon of 5 years after implementation. The model assumed that 100 new cases of mCRC were treated at this system with FOLFIRI+bev each year. Patients were dosed either based on their genetic variant status and anthropometrics or based on their anthropometrics alone. We included costs for genetic testing, medications and administration costs incurred to treat the disease, medications and administration costs to manage adverse events, clinic and hospitalization costs, and the salaries of providers needed to interpret and implement the genetic dosing approach. Costs were discounted at a 3% per annum rate and reported in 2018 dollars. Sensitivity analyses were conducted to test the impact of assumptions on the validity of the model.

RESULTS: The expected total cost over five years was $12,974,000 for a health care system that did not adopt genetic dosing. When 100% of the patients within the system received genetic dosing, the expected cost incurred by the system was $12,819,000, which is a savings of $155,000 or 1.2%.

CONCLUSIONS: Implementation of genetically-guided dosing for FOLFIRI+bev in patients with mCRC is cost-saving from the perspective of the health care system over a 5-year time horizon. Further work should be done to determine how to implementation, and the impact of improved outcomes due to a reduction of avoidable adverse events.