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 Can$38,016 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.
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Funding statements
This research was supported by grant no. RE01-061 from the Ontario Research Fund. Katherine Siminovitch is supported by a Canada Research Chair award and the Sherman Family Chair in Genomic Medicine. The Pharmacoeconomics Research Unit is supported by Cancer Care Ontario and the Ministry of Health. This research does not reflect the views of the funders.
Conflict of interest disclosures
Dr. Sandra Black has received speaker’s honoraria from Pfizer, Eisai, and Novartis, and ad hoc consulting fees from Pfizer, Novartis, GlaxoSmithKline, Roche, Bristol-Myers Squibb, and Elan. Dr. Black’s research unit has received research funds from Pfizer, GlaxoSmithKline, Lundbeck, Roche, and Novartis. The others authors have no conflicts of interest that are directly relevant to the content of this article.
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Djalalov, S., Yong, J., Beca, J. et al. Genetic Testing in Combination with Preventive Donepezil Treatment for Patients with Amnestic Mild Cognitive Impairment. Mol Diagn Ther 16, 389–399 (2012). https://doi.org/10.1007/s40291-012-0010-7
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DOI: https://doi.org/10.1007/s40291-012-0010-7