Cost-Utility Analysis of Polygenic Risk Score in the Prevention of Type 2 Diabetes – an Object-Oriented Individual-Level Model with Probabilistic Sensitivity Analysis

Speaker(s)

Martikainen JA1, Lehtimäki AV1, Jalkanen K1, Lavikainen P1, Paajanen T2, Marjonen H2, Kristiansson K2, Lindström J2, Perola M2
1University of Eastern Finland, Kuopio, Finland, 2Finnish Institute for health and welfare, Helsinki, Finland

Presentation Documents

OBJECTIVES: Type 2 diabetes (T2D) is a significant public health challenge. Obesity, unhealthy diet, and low physical activity are main risk factors of T2D, but genetic risk is also a factor in developing T2D. Recently, genomic-based polygenic risk scores (PRSs) have been suggested to improve the accuracy of risk prediction. The aim of this study was to assess the cost-utility of additional PRS testing (as a part of overall risk assessment) followed by a lifestyle intervention and an additional medical therapy when estimated 10-year overall risk for T2D exceeded 20% among individuals screened as high-risk based on traditional risk factors only.

METHODS: For a cost-utility analysis, an individual-level state-transition model with PSA was constructed. Model parameters were estimated based on the national FINRISK follow-up study and other real-world datasets. The model was built utilizing object-oriented programming paradigm: an object was created to represent every individual virtually. In turn each individual was assigned into a cohort object. Cost-effectiveness acceptability curve (CEAC) and the expected value of perfect information (EVPI) were also estimated. Cohort-level PSA was used in evaluating the impact of simultaneous variation in model parameters on the model results.

RESULTS: The use of targeted PRS strategy reclassified 12.4% of individuals as very high-risk individuals who would have been originally classified as high-risk. Over a lifetime horizon, the targeted PRS was the dominant strategy. PSA showed that PRS remained dominant in almost all simulations. However, there is still decision uncertainty since the probability of cost-effectiveness at a WTP of 0€/QALY was 63.0%. The corresponding EVPI estimate was 243€ per an individual.

CONCLUSIONS: The results of the study showed that PRS provides moderate additional value in risk screening leading to potential cost savings and better quality of life, comparing with the current T2D risk screening.

Code

EE323

Topic

Economic Evaluation, Methodological & Statistical Research

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)