{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T04:04:42Z","timestamp":1773029082238,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Translational Sci"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Testing\n                    <jats:italic>thiopurine methyltransferase<\/jats:italic>\n                    (TPMT) enzyme activity or genotype prior to thiopurine prescribing is recommended to reduce the risk of moderate to severe\u2014and potentially fatal\u2014myelosuppression in poor or intermediate TPMT metabolizers. Despite this, only about one\u2010third of individuals prescribed thiopurines in Australia currently receive TPMT testing. The budgetary implications of expanding testing to align with guidelines remain unclear. We conducted a budget impact analysis from the Australian healthcare system perspective, comparing costs under current versus increased TPMT testing uptake. Phenotype frequencies among thiopurine users were estimated using ancestry\u2010stratified prescribing data from the Person Level Integrated Data Asset of the Australian Bureau of Statistics combined with published phenotype distribution by ancestry. A simulation model was developed, incorporating phenotype frequencies, phenotype\u2010specific hospitalization risks, and costs of testing and hospitalizations. In a hypothetical cohort of 10,000 thiopurine users, current testing rates of 32.5%\u201339.8% identify approximately 296 poor or intermediate metabolizers, leaving 586 individuals at elevated risk undetected. Increasing testing uptake by 10 percentage points from baseline could prevent 16 hospitalizations and save AUD$88,113 in hospital costs, leading to a mean net saving of AUD$42,728 (95% CI: AUD$41,685\u2014AUD$43,770). The number needed to test to prevent one hospitalization was approximately 63. As myelosuppression represents a serious and potentially life\u2010threatening adverse drug reaction, expanding TPMT testing offers a cost\u2010effective, high\u2010yield strategy to enhance patient safety and reduce preventable healthcare burden. These findings support more systematic integration of pharmacogenomic testing into routine thiopurine prescribing in Australia.\n                  <\/jats:p>","DOI":"10.1111\/cts.70389","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T10:55:56Z","timestamp":1769770556000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Economic Impact of Expanded\n                    <scp>TPMT<\/scp>\n                    Testing to Prevent Thiopurine\u2010Induced Myelosuppression in Australia: A Budget Impact Analysis"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9771-3986","authenticated-orcid":false,"given":"Bella D.","family":"Ianni","sequence":"first","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Kolling Institute, Faculty of Medicine and Health The University of Sydney and the Northern Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Department of Pharmacy Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0831-9046","authenticated-orcid":false,"given":"Mohammad Afshar","family":"Ali","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Kolling Institute, Faculty of Medicine and Health The University of Sydney and the Northern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7758-6087","authenticated-orcid":false,"given":"Chin Hang","family":"Yiu","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Kolling Institute, Faculty of Medicine and Health The University of Sydney and the Northern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2922-8837","authenticated-orcid":false,"given":"Edwin C. K.","family":"Tan","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Kolling Institute, Faculty of Medicine and Health The University of Sydney and the Northern Sydney Local Health District  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-6837","authenticated-orcid":false,"given":"Christine Y.","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"},{"name":"Kolling Institute, Faculty of Medicine and Health The University of Sydney and the Northern Sydney Local Health District  Sydney New South Wales Australia"},{"name":"Department of Pharmacy Royal North Shore Hospital  St Leonards New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"CPIC \u201cClinical Pharmacogenetics Implementation Consortium \u201d(2024) https:\/\/cpicpgx.org\/."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1342-5"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14101032"},{"key":"e_1_2_12_5_1","unstructured":"MBS \u201cMBS Online \u201d(2024) https:\/\/www.mbsonline.gov.au\/internet\/mbsonline\/publishing.nsf\/Content\/the\u2010mbs."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/14622416.2024.2382078"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.31128\/AJGP-10-18-4733"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-021-01144-1"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.14139"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2019.04.020"},{"key":"e_1_2_12_11_1","volume-title":"Azathioprine","author":"Mohammadi O.","year":"2023"},{"issue":"4","key":"e_1_2_12_12_1","first-page":"199","article-title":"The Impact of Thiopurine\u2010S\u2010Methyltransferase Genotype on the Adverse Drug Reactions to Azathioprine in Patients With Inflammatory Bowel Diseases","volume":"114","author":"Hlavaty T.","year":"2013","journal-title":"Bratislavsk\u00e9 Lek\u00e1rske Listy"},{"key":"e_1_2_12_13_1","volume-title":"Thioguanine Therapy and TPMT and NUDT15 Genotype, in Medical Genetics Summaries [Internet]","author":"Dean L.","year":"2020"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871530318666181119153522"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2010.320"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2217\/pgs.09.155"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.4631"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.08.2291"},{"key":"e_1_2_12_19_1","volume-title":"Person\u2010Level Integrated Data Asset (PLIDA)","author":"Australian Bureau of Statistics","year":"2024"},{"key":"e_1_2_12_20_1","first-page":"1","article-title":"Assessment of Thiopurine Methyltransferase Activity in Patients Prescribed Azathioprine or Other Thiopurine\u2010Based Drugs","volume":"196","author":"Booth R. 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