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Economic impact of a genetic test for cisplatin-induced ototoxicity

The Pharmacogenomics Journal volume 12, pages 205–213 (2012)Cite this article

A Corrigendum to this article was published on 24 July 2012

Abstract

Cisplatin is a widely used chemotherapy drug in the treatment of pediatric solid tumors, but it is associated with significant rates of ototoxicity (medication-induced hearing loss). A genetic test has recently been developed that can help predict the likelihood that a cisplatin-treated pediatric patient will develop ototoxicity. This study estimates the potential economic impact of this test. Assuming that an alternative, non-preferred, medication to cisplatin exists that it is as efficacious as cisplatin but without the risk of hearing loss, and that the alternative treatment is no more expensive than current practice, we have estimated that administering this genetic test to every pediatric cancer patient for whom cisplatin is first-line therapy could potentially avoid an average of $71 168 in societal costs per tested patient. This translates into a potential present value savings of over $2.4 million annually in British Columbia and over $19.6 million in Canada.

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Author information

Authors and Affiliations

  1. Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada

    F Dionne, C Mitton, R Rassekh, B Brooks, C Ross, M Hayden & B Carleton

Authors
  1. F Dionne
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  2. C Mitton
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  3. R Rassekh
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  4. B Brooks
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  5. C Ross
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  6. M Hayden
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  7. B Carleton
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Corresponding author

Correspondence to C Mitton.

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The authors declare no conflict of interest.

Appendix A

Appendix A

Annual costs associated with ototoxicity

Children diagnosed with ototoxicity between the ages of 0 and 5

Children diagnosed with ototoxicity between the ages of 6 and 11

Children diagnosed with ototoxicity between the ages of 12 and 18

Notes:

  • All cost estimates, except the therapy/support services (see below), were provided by Beth Brooks, Registered Audiologist, BC Children's Hospital and validated by two other audiologists: Anne Follows, BC Early Hearing Program Hearing Equipment Plan Manager, Regional Coordinator and Audiologist Nanaimo Health Unit Audiology Clinic and an audiologist working in sales with a private equipment supplier.

  • These cost estimates are specific to BC but while Beth Brooks acknowledges that there are regional variations in costs and funding mechanisms, in her opinion (supported by the audiologist working in sales with a private equipment supplier), these estimates are reasonably reflective of both professional services and equipment costs across North America.

Therapy/support services

  • The $18 300 per year for grade 3 or 4 hearing loss for school-related services is paid for by the Ministry of Education. Ministry of Education website http://www.bced.gov.bc.ca/specialed/special_ed_policy_manual.pdfpage=108 section H13 page 144

  • The $6600 per year for grade 3 or 4 hearing loss pre-schoolers is provided through the BC Early Hearing Program for children diagnosed with such hearing loss before 2 years old. Children diagnosed between ages 2 and 5 years have similar coverage provided through different programs—we used the same $6600 to estimate the total value of these other programs. The BC Early Hearing Program and other programs only include 2 years of direct funding. Funding for remaining years comes from public health infant/pre-school services, private insurance or out-of-pocket spending (therefore, classified as health-care costs).

Equipment

  • The yearly costs for hearing aids have been calculated based on binaural amplification with replacement every 4 years including earmolds, batteries and fitting fees as follows:

    • ○ Hearing aid @ $1200 * 2 ears=$2400/4 years=$600/year

    • ○ Batteries @ $1 * 6/month * 2 ears *12 months=$144/year

    • ○ Earmolds @ $45 * 2 ears * 3 sets/year (average for children <6 years old)=$270

    • ○ Earmolds @ $45 * 2 ears * 1 set/year (average for children 6 years old or greater)=$90

    • ○ Total hearing aid cost/year:

      • Age 0–6 years: $600+$144+$270=$1014

      • Age >6 years: $600+$144 +$ 90=$834

    • ○ For adults, the equipment cost is the same but earmolds are needed only every 4 years with the new hearing aids; therefore, the annual cost is estimated at $766.50 ($600 for the hearing aids, $144 for batteries and $22.50 for the earmolds)

These are current costs in 2011 based on manufacturers’ pricing less discounts passed on by public health services plus fitting fees. Hearing aid costs in the private sector tend to be higher ($1500–$2000 per hearing aid plus batteries and earmolds). This calculation assumes adequately stable hearing levels not requiring change of hearing aid.

  • The yearly cost for FM systems has been calculated based on binaural fitting with replacement every 5 years including estimated costs for maintenance/repair/replacement parts as follows:

    • Binaural system=$3200/5 years=$640/year

    • Microphone replacement=2 * $150=$300/5 years=$60

    • Maintenance/repairs=$800/5 years=$160

    • Total FM cost/year=$640+$60+$160=$860/year

These are current costs in 2011 based on manufacturers’ pricing purchased through public health services for use in any environment (school, home, recreation and so on). Due to bulk purchase by Ministry of Education in British Columbia, FM for school use only is less.

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Dionne, F., Mitton, C., Rassekh, R. et al. Economic impact of a genetic test for cisplatin-induced ototoxicity. Pharmacogenomics J 12, 205–213 (2012). https://doi.org/10.1038/tpj.2011.15

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