Purpose: To evaluate the cost-effectiveness of APOEe4 testing in combination with preventive Donepezil treatment in AMCI patients in Canada in delaying the onset of AD.
Method: We performed a cost-effectiveness analysis using a Markov model, generating parameter estimates based on a thorough review of the literature. The base case was assumed to be a 70-year-old AMCI. The model used a societal perspective and a time horizon of 30 years. Two strategies were evaluated: genetic testing and preventive Donepezil treatment for APOEe4 gene carriers vs. no testing (the current standard care in Canada). Outcome measures were quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios.
Result: The genetic testing and Donepezil treatment combination strategy resulted in a gain of 0.055 QALYs, when compared to no testing. The incremental cost was CAD $ 955 with Donepezil treatment; consequently, the incremental cost-effectiveness ratio (ICER) for the base case was $ 17,499. The cost of the genetic test and the cost of AD had a small effect on the cost-effectiveness results. However, the ICER was sensitive to the prevalence of the APOE alleles, the rate of progression to AD and the cost of AD. The ICER was also lower for females than for males.
Conclusion: Genetic testing in combination with preventive Donepezil treatment for AMCI patients may be economically attractive. Our findings are limited by the substantial uncertainties around the long-term efficacy of Donepezil preventive treatment and the rate of progression to AD for AMCI APOEe4 carriers and non-carriers.
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