Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2026
Exploratory Economic Evaluation of a Genome Precision Report in Kidney and Liver Transplantation Care.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Sjaaf Florencia, Pang Lokman, Kuo Stephanie F T, Vaz Karl, Thompson Bryony A, Goranitis Ilias, Gaff Clara, Martyn Melissa, James Paul, Schilling Chris, Melbourne Genomics Health Alliance Clinical Change Project
Аннотация
OBJECTIVES: To investigate the impact of including 4 domains of kidney and liver transplantation care (tacrolimus optimization, postoperative complications prevention, screening, and familial testing) on the cost-effectiveness of a genome precision report and identify key parameters driving the cost-effectiveness.
METHODS: A decision tree model-based cost-utility analysis comparing a genome precision report with standard nongenomic practice from the Australian healthcare system perspective was conducted, using data from the literature (lifetime costs and quality-adjusted life-years [QALYs] discounted at 3% to 5%, following the source studies) and the Clinical Change Project study. Costs were in 2024 Australian dollars (US dollar values converted using purchasing power parities). We conducted a stepped evaluation that sequentially added each domain, and deterministic and probabilistic sensitivity analyses.
RESULTS: With only the tacrolimus optimization and the postoperative complication prevention domains included, the incremental cost and QALY compared with standard practice were AU$2030 (US$1471) and 0.0003, respectively (incremental cost-effectiveness ratio: AU$6.2 million [US$4.5 million] per QALY gained). Including all 4 domains reduced the incremental cost to AU$1800 (US$1300) and increased the QALYs gained to 0.0170 (incremental cost-effectiveness ratio: AU$106 000 [US$77 000] per QALY gained). Results were sensitive to genomic test cost, incremental cost and QALY after germline cancer and cardiovascular conditions screening, rejection rates, and cascade-testing uptake. The probability of cost-effectiveness was 0.14 to 0.79 at AU$50 000 to 150 000 (US$36 234-108 701) per QALY thresholds.
CONCLUSION: Considering wider benefits of genomic medicine can materially change its estimated cost-effectiveness. Lower genomic test cost and better quantification of genotype-guided tacrolimus dosing benefits could improve its cost-effectiveness in Australia.
METHODS: A decision tree model-based cost-utility analysis comparing a genome precision report with standard nongenomic practice from the Australian healthcare system perspective was conducted, using data from the literature (lifetime costs and quality-adjusted life-years [QALYs] discounted at 3% to 5%, following the source studies) and the Clinical Change Project study. Costs were in 2024 Australian dollars (US dollar values converted using purchasing power parities). We conducted a stepped evaluation that sequentially added each domain, and deterministic and probabilistic sensitivity analyses.
RESULTS: With only the tacrolimus optimization and the postoperative complication prevention domains included, the incremental cost and QALY compared with standard practice were AU$2030 (US$1471) and 0.0003, respectively (incremental cost-effectiveness ratio: AU$6.2 million [US$4.5 million] per QALY gained). Including all 4 domains reduced the incremental cost to AU$1800 (US$1300) and increased the QALYs gained to 0.0170 (incremental cost-effectiveness ratio: AU$106 000 [US$77 000] per QALY gained). Results were sensitive to genomic test cost, incremental cost and QALY after germline cancer and cardiovascular conditions screening, rejection rates, and cascade-testing uptake. The probability of cost-effectiveness was 0.14 to 0.79 at AU$50 000 to 150 000 (US$36 234-108 701) per QALY thresholds.
CONCLUSION: Considering wider benefits of genomic medicine can materially change its estimated cost-effectiveness. Lower genomic test cost and better quantification of genotype-guided tacrolimus dosing benefits could improve its cost-effectiveness in Australia.