Horsfall, LJ; (2005) The clinical and economic consequences of genetic testing to prevent irinotecan-induced toxicity: evaluating a pharmacogenetic health technology. Masters thesis , University of York.

Abstract

Objective: To develop and apply a set of criteria to current evidence to evaluate a pharmacogenetic health intervention. Design: A two-phase design using qualitative techniques to develop a set of criteria appropriate for pharmacogenetic technology assessment, and application of these criteria to qualitatively and quantitatively evaluate the clinical and economic consequences a pharmacogenetic strategy to prevent irinotecan-induced toxicities. Methods: Published literature and guidelines were used to derive a set of criteria to measure the potential outcomes of a pharmacogenetic intervention. The main outcomes of clinical effectiveness and cost-effectiveness were measured using systematic review including meta-analysis and decision modelling. Results: A pharmacogenetic intervention to reduce irinotecan-induced toxicity has high potential for clinical and cost-effectiveness for the NHS and further research would be cost-effective. Conclusions: Lack of research interest and perceptions of the exceptional nature of genetics could in part be responsible for the absence of pharmacogenetic technologies from clinical practice. Clinical-effectiveness organisations need to develop appropriate guidelines using methods from health services research for appraising pharmacogenetic technologies. Patients with genetic condition Gilbert’s syndrome are at high-risk of severe toxicity to irinotecan chemotherapy and by pre-treatment pharmacogenetic screening could be beneficial both clinically and economically.

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