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Cost-effectiveness of MODY genetic testing: translating genomic advances into practical health applications. Diabetes Care 2014;37(1):202-9

Date

09/13/2013

Pubmed ID

24026547

Pubmed Central ID

PMC3867988

DOI

10.2337/dc13-0410

Abstract

OBJECTIVE To evaluate the cost-effectiveness of a genetic testing policy for HNF1A-, HNF4A-, and GCK-MODY in a hypothetical cohort of type 2 diabetic patients 25-40 years old with a MODY prevalence of 2%. RESEARCH DESIGN AND METHODS We used a simulation model of type 2 diabetes complications based on UK Prospective Diabetes Study data, modified to account for the natural history of disease by genetic subtype to compare a policy of genetic testing at diabetes diagnosis versus a policy of no testing. Under the screening policy, successful sulfonylurea treatment of HNF1A-MODY and HNF4A-MODY was modeled to produce a glycosylated hemoglobin reduction of -1.5% compared with usual care. GCK-MODY received no therapy. Main outcome measures were costs and quality-adjusted life years (QALYs) based on lifetime risk of complications and treatments, expressed as the incremental cost-effectiveness ratio (ICER) (USD/QALY). RESULTS The testing policy yielded an average gain of 0.012 QALYs and resulted in an ICER of 205,000 USD. Sensitivity analysis showed that if the MODY prevalence was 6%, the ICER would be ~50,000 USD. If MODY prevalence was >30%, the testing policy was cost saving. Reducing genetic testing costs to 700 USD also resulted in an ICER of ~50,000 USD. CONCLUSIONS Our simulated model suggests that a policy of testing for MODY in selected populations is cost-effective for the U.S. based on contemporary ICER thresholds. Higher prevalence of MODY in the tested population or decreased testing costs would enhance cost-effectiveness. Our results make a compelling argument for routine coverage of genetic testing in patients with high clinical suspicion of MODY.

Author List

Naylor RN, John PM, Winn AN, Carmody D, Greeley SA, Philipson LH, Bell GI, Huang ES

Author

Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Cohort Studies
Cost-Benefit Analysis
Diabetes Mellitus, Type 2
Female
Genetic Testing
Genomics
Hepatocyte Nuclear Factor 1-alpha
Hepatocyte Nuclear Factor 4
Humans
Male
Models, Theoretical
Precision Medicine
Protein-Serine-Threonine Kinases
Quality-Adjusted Life Years
Sulfonylurea Compounds
Translational Medical Research
United States
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a