Comments on: Cost-effectiveness of DPYD genotyping prior to capecitabine administration for metastatic breast cancer.

DPYD genotyping before capecitabine therapy represents a clinically actionable pharmacogenomic strategy to reduce avoidable fluoropyrimidine-related toxicity in metastatic breast cancer. Commenting on the cost-effectiveness analysis by Chiddarwar, Blaes and Kuntz, this correspondence supports the authors' findings while extending the discussion from economic value to implementation readiness. We propose that DPYD testing should be evaluated through a globally transferable framework incorporating ancestry-aware variant coverage, rapid turnaround pathways, genotype-linked dose decision support, budget-impact assessment and real-world toxicity surveillance. Such an approach may help translate cost-effective pharmacogenomics into equitable, operationally feasible breast cancer care across diverse health systems.