Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: An exploratory economic evaluation of personalized medicine

Sandjar Djalalov, Jean Yong, Jaclyn Beca, Sandra Black, Gustavo Saposnik, Zahra Musa, Katherine Siminovitch, Myla Moretti, Jeffrey S Hoch

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Objective: To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) ε4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada. Methods: We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life-years (QALYs), using utilities from the literature. Costs were also based on the literature and, when appropriate, Ontario sources. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) analysis was conducted to explore the value of future research. Results: The base case results in our exploratory study suggest that the combination of genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of 1,015 (in 2009 Canadian dollars [Can]), compared with the standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was Can38,016 per QALY. The ICER was sensitive to the effectiveness of donepezil in slowing the rate of progression to Alzheimer's disease (AD), utility in AMCI patients, and AD and donepezil treatment costs. EVPI analysis showed that additional information on these parameters would be of value. Conclusion: Using presently available clinical evidence, this exploratory study illustrates that genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients. Future research on the effectiveness of preventive donepezil as a targeted therapy is recommended.

Original languageEnglish (US)
Pages (from-to)389-399
Number of pages11
JournalMolecular Diagnosis and Therapy
Volume16
Issue number6
DOIs
StatePublished - Dec 2012
Externally publishedYes

ASJC Scopus subject areas

  • Genetics
  • Molecular Medicine
  • Medicine(all)
  • Pharmacology

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