Beca J.M., Djalalova D.H., Djalalov S.C., Hoch D.S. 4879

Economic evaluation of genetic testing in combination with preventive donepezil treatment for amnestic mild cognitive impairment patients

Objective: To evaluate the cost-effectiveness of genetic screening for Apolipoprotein ε4 (APOE ε4) allele in combination with preventive donepezil treatment in comparison to 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) and cost. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) was conducted to explore the value of future research.
Results: The base case results in our exploratory study suggest combined genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of CAD $870 compared to standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was $32,585 per QALY. The ICER was sensitive to the and effectiveness of donepezil in slowing rate of progression to AD, Donepezil treatment cost and treatment of AD patients. EVPI analysis showed that additional information on these parameters would be of value.
Conclusion: Using presently available clinical evidence, this exploratory study illustrates 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.
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