Cost-effectiveness of a gene sequencing test for Alzheimer's disease in Ontario

Nicolas Iragorri; Danielle Toccalino; Sujata Mishra; Brian Cf Chan; Allison A Dilliott; John F Robinson; Robert A Hegele; Rebecca Hancock-Howard; ONDRI Investigators

doi:10.1007/s12687-022-00619-7

Cost-effectiveness of a gene sequencing test for Alzheimer's disease in Ontario

J Community Genet. 2023 Apr;14(2):135-147. doi: 10.1007/s12687-022-00619-7. Epub 2022 Nov 25.

Authors

Nicolas Iragorri¹, Danielle Toccalino², Sujata Mishra², Brian Cf Chan³, Allison A Dilliott⁴, John F Robinson⁵, Robert A Hegele^{5

6}, Rebecca Hancock-Howard²; ONDRI Investigators

Affiliations

¹ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. nicolas.iragorri@mail.utoronto.ca.
² Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ KITE - Toronto Rehabilitation Institute, Institute for Health Policy, Management and Evaluation, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
⁵ Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Abstract

Alzheimer's f disease (AD) affects approximately 250,000 Ontarians, a number that is expected to double by 2040. The Ontario Neurodegenerative Disease Research Initiative has developed an in-province genetic test (ONDRISeq), which currently runs in Ontario in an experimental capacity. The aim of this study is to estimate the costs and health outcomes associated with ONDRISeq to diagnose AD relative to out-of-country (OOC) testing (status quo). A cost-utility analysis was developed for a hypothetical cohort of 65-year-olds at risk of AD in Ontario over a 25-year time horizon. Costs and health outcomes (quality-adjusted life years (QALYs)) were assessed from a healthcare payer perspective. Cost-effectiveness was assessed with a $50,000 cost-effectiveness threshold. Probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty. ONDRISeq saved $54 per patient relative to OOC testing and led to a small QALY gain in the base case (0.0014 per patient). Results were most sensitive to testing costs, uptake rates, and treatment efficacy. ONDRISeq represented better value for money relative to OOC testing throughout 75% of 10,000 probabilistic iterations. Using ONDRISeq is expected to provide health system cost savings. Switching to ONDRISeq for AD genetic testing in Ontario would be dependent on the ability to accommodate the expected testing volumes.

Keywords: Alzheimer’s; Cost-effectiveness; Markov model; Neurogenetics.