Economic evaluation of a new genetic risk score to prevent nephropathies in type-2 diabetic patients
The current screening method for diabetic nephropathy (DN) is based upon the detection of urinary albumin and the decline of estimated glomerular filtration rate, which occurs relatively late in the course of the disease. A polygenic risk score (PRS) was developed for early prediction of the risk for type 2 diabetes (T2D) patients who experience DN. The aim of this study was to assess the economic impact of the implementation of the PRS for the prevention of DN in T2D patients, compared to usual screening methods in Canada. First, a systematic literature review was conducted to examine all published economic evaluations in T2D and DN. The main trends in modelling technics obtained from this review were used to conduct a cost-utility analysis using a Markov model. Health states include pre-end-stage renal disease (Pre-ESRD), ESRD and death. Model efficacy parameters were based on prediction of outcome data by polygenic-risk testing of the ADVANCE trial. Analyses were conducted from Canadian healthcare and societal perspectives. Over a lifetime horizon, the PRS was a dominant strategy compared to usual screening methods, from both a healthcare system and societal perspective. In other words, the PRS was less expensive and more effective in terms of quality-adjusted life years compared to usual screening technics. Deterministic and probabilistic sensitivity analyses showed that results remained dominant in the majority of simulations. This economic evaluation demonstrates that the adoption of the PRS would not only be cost saving but would also help prevent ESRD and improve patients’ quality of life.
Diabetic nephropathy End-stage renal disease Type 2 diabetes mellitus Polygenic risk score Cost-utility analysis Markov model