Quantifying the Clinical and Economic Consequences of DPYD Genotype-Guided Fluoropyrimidine Dosing in Colorectal Cancer Patients: A Case Study from Ontario, Canada
Bibliographic record
Abstract
Colorectal cancer patients receiving fluoropyrimidine-based chemotherapy are at risk of experiencing treatment-related adverse events (AEs), and mortality. The risk is increased for patients with reduced dihydropyrimidine dehydrogenase activity due to impaired-function variants in the DPYD gene. DPYD genotype-guided treatment has been shown to reduce treatment-related AEs and corresponding costs through the administration of lower doses for DPYD variant carriers. This thesis compared clinical and economic outcomes between DPYD genotype-guided patients and standard-of-care patients derived from historic and contemporaneous control groups using health administrative data from Ontario, Canada. There were no differences in toxicity prevalence, or cancer-related mortality between the DPYD genotype-guided group and most control groups following inverse probability weighting. The DPYD genotype-guided group had a $5,241 reduction in per-patient cancer costs when compared with the historic control, but a $1,401 - $1,530 increase when compared with the contemporaneous controls. Future research is suggested to better understand the mixed results.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".