Exploratory Economic Evaluation of a Genome Precision Report in Kidney and Liver Transplantation Care.

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.