The cost-effectiveness of interleukin-1 genetic testing for periodontal disease.
BACKGROUND
A genetic test for a composite interleukin-1 (IL-1) genotype is being marketed to predict risk for progression of periodontal disease. The objective of this study was to determine the clinical scenario required to produce cost-effective results with the use of IL-1 testing to identify high-risk patients.


METHODS
A disease simulation model was developed using decision-analytic techniques and a 30-year time frame.


RESULTS
Using different modeling scenarios, the genetic test produced results ranging from cost savings of $830,140 and 52.8 fewer cases of severe periodontitis to increased costs of $300,430 and 3.6 additional cases of severe periodontitis (per 1,000 patients). Three parameters in the analysis were highly influential: 1) the compliance rate for maintenance therapy in test positive versus non-tested patients; 2) the effectiveness of non-surgical therapy; and 3) the relative risk of disease progression for test positive patients.


CONCLUSIONS
The model produced a wide range of outcomes reflecting our incomplete understanding of the biology, optimal treatment, and genetic susceptibility of periodontal diseases. However, the model demonstrates that three clinical parameters are highly influential in determining if IL-1 testing can be implemented in a primary care setting in a cost-effective manner.
Higashi
Mitchell K
MK
Pharmaceutical Outcomes Research & Policy Program, University of Washington, Seattle 98195-7630, USA.
Veenstra
David L
DL
del Aguila
Michael
M
Hujoel
Philippe
P
D000328:Adult; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003777:Dental Prophylaxis; D018450:Disease Progression; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D005820:Genetic Testing / Q000191:economics*; D005838:Genotype; D006801:Humans; D007375:Interleukin-1 / Q000235:genetics*; D008297:Male; D008390:Markov Chains; D008954:Models, Biological; D010349:Patient Compliance; D010518:Periodontitis / Q000175:diagnosis* / Q000191:economics / Q000235:genetics*; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D016540:Smoking Cessation
D007375:Interleukin-1