Summary Background : Azathioprine is a useful agent in the management of inflammatory bowel disease. Its use is limited by its side‐effect profile. Marrow toxicity occurs in approximately 3.2% of patients and is known to be associated with diminished thiopurine methyltransferase enzyme activity resulting from genetic polymorphisms. Aim : To evaluate the cost‐effectiveness of screening for thiopurine methyltransferase gene polymorphisms prior to initiation of azathioprine therapy. Methods : Analysis of the literature was undertaken to calculate the expected frequency of leucopenia and its relationship with thiopurine methyltransferase polymorphisms in a model of theoretical inflammatory bowel disease patients. Decision analysis was then applied to assess the cost of a pre‐treatment genotyping strategy, taking account of direct costs and cost per life‐year saved. Results : In 1000 inflammatory bowel disease patients treated with azathioprine, 32 will develop myelosuppression and one will die because of this. Of those who develop myelosuppression during azathioprine therapy, 32% are attributable to lower thiopurine methyltransferase activity. Pre‐treatment genotyping costs £347 per life‐year saved for a 30 year old and £817 per life‐year saved for a 60 year old. This compares favourably with other health care technologies. Conclusion : The use of pre‐treatment screening for thiopurine methyltransferase polymorphisms in inflammatory bowel disease patients commencing azathioprine therapy represents good value for money.

SUMMARY BackgroundMyelosuppression occurs in 2-7% of inflammatory bowel disease (IBD) patients treated with azathioprine, and can be associated with reduced activity of thiopurine methyltransferase (TPMT) in some patients. It has been proposed that pretreatment assessment of TPMT status reduces the incidence of toxicity and is cost-effective.

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