The cost-effectiveness of @entity6912 genotyping before @entity14 treatment with XXXX from the perspective of the German statutory health insurance.

@entity1 @entity6912 @entity2600 @entity1398 @entity14 @entity694
BACKGROUND: The evidence concerning the cost-effectiveness of @entity6912 *28 genotyping is ambiguous and does not allow drawing valid conclusions for Germany. This study evaluates the cost-effectiveness of @entity6912 genotyping in @entity1 with metastatic @entity14 undergoing @entity2600 -based chemotherapy compared to no testing from the perspective of the German statutory health insurance. MATERIAL AND METHODS: A decision-analytic Markov model with a life time horizon was developed. No testing was compared to two genotype-dependent therapy strategies: 1) dose reduction by 25%; and 2) administration of a prophylactic G-CSF growth factor analog for homozygous and heterozygous @entity1 . Probability, quality of life and cost parameters used in this study were based on published literature. Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Strategy 1 dominated all remaining strategies. Compared to no testing, it resulted in only marginal QALY increases (0.0002) but a cost reduction of    580 per @entity1 . Strategy 2 resulted in the same health gains but increased costs by    10 773. In the probabilistic analysis, genotyping and dose reduction was the optimal strategy in approximately 100% of simulations at a threshold of    50 000 per QALY. Deterministic sensitivity analysis shows that uncertainty for this strategy originated primarily from costs for @entity2600 -based chemotherapy, from the prevalence of @entity1398 among heterozygous @entity1 , and from whether dose reduction is applied to both homozygotes and heterozygotes or only to the former. CONCLUSION: This model-based synthesis of the most recent evidence suggests that pharmacogenetic @entity6912 testing prior to @entity2600 -based chemotherapy dominates non-personalized @entity694 care in Germany. However, as structural uncertainty remains high, these results require validation in clinical practice, e.g. based on a managed-entry agreement.
