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8CEP IS GENETIC TESTING IN COMBINATION WITH PREVENTIVE DONEPEZIL TREATMENT FOR PATIENTS WITH AMNESTIC MILD COGNITIVE IMPAIRMENT COST- EFFECTIVE?

Monday, October 19, 2009
Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)
Sandjar Djalalov, PhD1, Jean Hai Ein Yong, MASc2, Gustavo Saposnik, MD1, Zahra Musa, MHA2, Michael Mendelson3, Katherine Siminovitch, MD4 and Jeffrey Hoch, PhD5, (1)St. Michael's Hospital, Toronto, ON, Canada, (2)Cancer Care Ontario, Toronto, ON, Canada, (3)Caledon Institute of Social Policy, Toronto, ON, Canada, (4)Mount Sinai Hospital, Toronto, ON, Canada, (5)St. Michael's Hospital, University of Toronto, Toronto, ON, Canada

Purpose: To evaluate the cost-effectiveness of genetic testing for the mutation APOE e4 in combination with preventive Donepezil (Aricept®) treatment for amnestic mild cognitive impairment (AMCI) patients in Canada.

Method: A decision tree was constructed based on the costs and effects of the intervention: an APOE predictive genetic test and preventive treatment with Donepezil in the AMCI population. Clinical data from a RCT conducted in North America between 1999-2004 were used for the model. This study concluded that Donepezil was associated with a lower rate of progression to Alzheimer’s disease (AD) during the first 12 months of treatment in AMCI patients, although the rate of progression to AD after 3 years was not lower among patients with Donepezil than among those given placebo. Extensive sensitivity analyses were performed on the probability of progressing to AD, health state utility and healthcare costs.

Result: Using a 3 year time-horizon, the genetic testing with preventive Donepezil treatment strategy resulted in the gain of 0.003 QALYs, when compared to usual care, and an incremental cost of CAD $ 700. Consequently, the incremental cost-effectiveness ratio (ICER) for the base case is estimated to be $ 230,061/QALY. The prevalence of genetic mutations and cost of the genetic test had a small effect on the cost-effectiveness results; however, the ICER is sensitive to utility values, the rate of progression to AD, efficacy, and the cost of Donepezil preventive treatment.

Conclusion: Genetic testing in combination with preventive Donepezil treatment for AMCI patients may not be economically attractive in this setting. Additional research on the long-term effectiveness of Donepezil and APOE e4 genetic test values for predicting progression from AMCI to AD is needed to assess if there are potential health gains and cost-savings that may influence the cost-effectiveness of this intervention.

Candidate for the Lee B. Lusted Student Prize Competition

See more of: Poster Presentations, Session 2

See more of: 31st Annual Meeting of the Society for Medical Decision Making (October 18 - 21, 2009)