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Genetic Testing in Combination with Preventive Donepezil Treatment for Patients with Amnestic Mild Cognitive Impairment

An Exploratory Economic Evaluation of Personalized Medicine

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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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Authors and Affiliations

  1. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Sandjar Djalalov, Jean Yong, Jaclyn Beca, Gustavo Saposnik & Jeffrey S. Hoch

  2. Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada

    Sandjar Djalalov, Jean Yong, Jaclyn Beca, Zahra Musa & Jeffrey S. Hoch

  3. University of Toronto, Toronto, ON, Canada

    Sandra Black, Gustavo Saposnik, Katherine Siminovitch & Jeffrey S. Hoch

  4. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sandra Black

  5. Mount Sinai Hospital, Toronto, ON, Canada

    Katherine Siminovitch

  6. The Hospital for Sick Children, Toronto, ON, Canada

    Myla Moretti

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  1. Sandjar Djalalov
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Correspondence to Jeffrey S. Hoch.

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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

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