title: Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) ε4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada.
  
  
  METHODS
  We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life-years (QALYs), using utilities from the literature. Costs were also based on the literature and, when appropriate, Ontario sources. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) analysis was conducted to explore the value of future research.
  
  
  RESULTS
  The base case results in our exploratory study suggest that the combination of genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of $1,015 (in 2009 Canadian dollars [Can$]), compared with the standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was Can$38,016 per QALY. The ICER was sensitive to the effectiveness of donepezil in slowing the rate of progression to Alzheimer's disease (AD), utility in AMCI patients, and AD and donepezil treatment costs. EVPI analysis showed that additional information on these parameters would be of value.
  
  
  CONCLUSIONS
  Using presently available clinical evidence, this exploratory study illustrates that genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients. Future research on the effectiveness of preventive donepezil as a targeted therapy is recommended.
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Sandjar
authors.initials: S
authors.lastname: Djalalov
authors.forename: Jean
authors.initials: J
authors.lastname: Yong
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Beca
authors.forename: Sandra
authors.initials: S
authors.lastname: Black
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Zahra
authors.initials: Z
authors.lastname: Musa
authors.forename: Katherine
authors.initials: K
authors.lastname: Siminovitch
authors.forename: Myla
authors.initials: M
authors.lastname: Moretti
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000647:Amnesia / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000235:genetics; D002170:Canada; D016022:Case-Control Studies; D018890:Chemoprevention / Q000191:economics* / Q000379:methods; D060825:Cognitive Dysfunction / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000235:genetics; D003362:Cost-Benefit Analysis; D000077265:Donepezil; D005820:Genetic Testing / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007189:Indans / Q000191:economics / Q000627:therapeutic use*; D008390:Markov Chains; D058990:Molecular Targeted Therapy / Q000191:economics / Q000379:methods; D018697:Nootropic Agents / Q000191:economics / Q000627:therapeutic use; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D057285:Precision Medicine / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D059039:Standard of Care / Q000191:economics
chemical_list: D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil