DPYD Genotyping & Fluoropyrimidine: Cost & Outcomes
- A recent study presented at teh 2025 American Society of Clinical Oncology (ASCO) meeting highlights the benefits of pre-treatment DPYD genotyping in patients undergoing fluoropyrimidine (FP) chemotherapy.
- The cost analysis focused on the expenses associated with DPYD testing and hospitalizations related to FP toxicities.
- According to Morris, implementing routine DPYD genotyping significantly decreased FP-related hospitalizations.
Pre-treatment DPYD genotyping slashes hospitalizations adn saves money for cancer patients undergoing fluoropyrimidine chemotherapy. A recent study, presented at the 2025 ASCO meeting, reveals how this pharmacogenomic testing approach substantially reduces hospitalization rates among those with DPYD variants. The research unveils a cost-effective strategy: The study showed that pre-emptive genotyping led to savings of $37 per patient, and these savings are expected to increase after adding outpatient toxicity management and indirect costs.Pharmacists are key in implementing these pharmacogenomic testing programs, though insurance coverage represents a major barrier. Discover how News Directory 3 is following the ongoing efforts to improve patient safety and reduce healthcare costs. What does the future hold for DPYD testing?
DPYD Genotyping: Cost-Effective Cancer Care and Reduced Hospitalizations
Updated May 29, 2025
A recent study presented at teh 2025 American Society of Clinical Oncology (ASCO) meeting highlights the benefits of pre-treatment DPYD genotyping in patients undergoing fluoropyrimidine (FP) chemotherapy. Sarah Morris, a clinical pharmacogenomics specialist at Atrium Health Levine Cancer Institute, presented the findings, which demonstrate that DPYD genotyping not only reduces hospitalization rates among patients with DPYD variants but also leads to cost savings from a health-system perspective. The research underscores the real-world impact of pharmacogenomic testing in oncology.
The cost analysis focused on the expenses associated with DPYD testing and hospitalizations related to FP toxicities. Morris’s team compared the costs of pre-treatment testing, including standard doses for wild-type patients and reduced doses for variant carriers, against a scenario where no pre-treatment testing was performed. The analysis covered the first three months of FP treatment from a health-system viewpoint.
According to Morris, implementing routine DPYD genotyping significantly decreased FP-related hospitalizations. A study evaluating 442 patients showed that by testing patients before starting treatment and reducing the initial dose in DPYD variant carriers, the hospitalization rate in these carriers dropped from 64% to 25%. This reduction highlights the potential of DPYD genotyping to improve patient outcomes and reduce healthcare costs.
The study assigned monetary value to avoided adverse events, especially hospitalizations, using a weighted average cost of hospitalization for each patient group. This calculation utilized hospitalization cost data from North Carolina, sourced from the 2021 Healthcare Cost and Utilization Project Inpatient Database.
Morris noted that initial implementation costs for DPYD genotyping were covered by the institution and grant funding, with insurance billing starting near the end of 2023. The cost analysis revealed that pre-treatment testing resulted in savings of approximately $37 per patient compared to no pre-treatment testing, considering testing costs and hospitalizations. These savings are expected to increase when accounting for outpatient toxicity management and other indirect costs.
While the model primarily focused on direct medical costs, Morris acknowledged the significance of indirect costs such as missed workdays and caregiver responsibilities. These factors would likely further enhance the cost-effectiveness of DPYD testing by improving quality of life and reducing logistical burdens on patients and caregivers.
Morris strongly advocates for pre-treatment DPYD genotyping to become the standard of care in U.S. cancer centers. she cited a recent FDA safety announcement emphasizing the importance of informing patients about DPD deficiency risks and testing options. Additionally, NCCN guidelines for certain gastrointestinal cancers now recommend considering testing.
Insurance coverage remains a major obstacle to the widespread adoption of DPYD testing. Inconsistent policies and lengthy prior authorization processes create barriers. However, efforts are underway to engage payers and advocate for testing reimbursement, particularly given the recent NCCN guideline updates and growing recognition of the clinical value of DPYD testing.
Pharmacists play a crucial role in the success of pharmacogenomic testing programs like DPYD genotyping.At Atrium Health Levine Cancer Institute, clinical pharmacists facilitate testing, interpret results, recommend dose modifications, and educate providers and patients. Their involvement ensures testing is done preemptively, preventing costly hospitalizations.
The institution is actively working on integrating DPYD test orders into FP treatment plans to simplify the process for providers, making it an “opt-out” rather than “opt-in” approach.
What’s next
The continued advocacy for routine DPYD testing,coupled with ongoing research and engagement with payers,aims to improve patient safety and reduce healthcare costs associated with fluoropyrimidine chemotherapy. Further studies may explore the impact of preemptive testing on outpatient toxicity management and indirect costs, solidifying the value of DPYD genotyping in cancer care.