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Original Article
Incremental cost-effectiveness of algorithm-driven genetic testing versus no testing for Maturity Onset Diabetes of the Young (MODY) in Singapore
  1. Hai Van Nguyen1,
  2. Eric Andrew Finkelstein2,
  3. Shweta Mital2,
  4. Daphne Su-Lyn Gardner3
  1. 1School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada
  2. 2Health Services and Systems Research, Duke NUS Medical School, Singapore
  3. 3Department of Endocrinology, Singapore General Hospital, Singapore
  1. Correspondence to Dr Hai Van Nguyen, School of Pharmacy, Memorial University of Newfoundland, St. John’s, A1B 3V6, Canada; hvnguyen{at}mun.ca

Abstract

Background Offering genetic testing for Maturity Onset Diabetes of the Young (MODY) to all young patients with type 2 diabetes has been shown to be not cost-effective. This study tests whether a novel algorithm-driven genetic testing strategy for MODY is incrementally cost-effective relative to the setting of no testing.

Methods A decision tree was constructed to estimate the costs and effectiveness of the algorithm-driven MODY testing strategy and a strategy of no genetic testing over a 30-year time horizon from a payer’s perspective. The algorithm uses glutamic acid decarboxylase (GAD) antibody testing (negative antibodies), age of onset of diabetes (<45 years) and body mass index (<25 kg/m2 if diagnosed >30 years) to stratify the population of patients with diabetes into three subgroups, and testing for MODY only among the subgroup most likely to have the mutation. Singapore-specific costs and prevalence of MODY obtained from local studies and utility values sourced from the literature are used to populate the model.

Results The algorithm-driven MODY testing strategy has an incremental cost-effectiveness ratio of US$93 663 per quality-adjusted life year relative to the no testing strategy. If the price of genetic testing falls from US$1050 to US$530 (a 50% decrease), it will become cost-effective.

Conclusion Our proposed algorithm-driven testing strategy for MODY is not yet cost-effective based on established benchmarks. However, as genetic testing prices continue to fall, this strategy is likely to become cost-effective in the near future.

  • algorithm-driven genetic testing
  • maturity onset diabetes of the young
  • gene panel testing
  • cost-effectiveness
  • Singapore

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Footnotes

  • Contributors HVN led the model development and contributed to data analysis; SM contributed to data analysis; EF and DS-LG conceptualised the initial idea; DS-LG conducted clinical investigations that provided model inputs. All authors contributed to manuscript writing and manuscript revisions. HN and DS-LG are the overall guarantors of the manuscript.

  • Funding DS-LG and EF received funding from the Stratified Medicine Programme Office, a joint initiative by the Biomedical Research Council and the National Medical Research Council, Singapore.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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