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|Title:||Modeling the Impact of Genetic Screening Technologies on Healthcare: Theoretical Model for Asthma in Children|
|Authors:||GUTIERREZ DE MESA Emma; HIDALGO Ignacio; CHRISTIDIS PANAYOTIS; CISCAR MARTINEZ JUAN CARLOS; VEGAS Eva; IBARRETA RUIZ DOLORES|
|Citation:||Molecular Diagnosis & Therapy vol. 11 no. 5 p. 313-323|
|Publisher:||ADIS INTERNATIONAL LTD|
|Type:||Articles in Journals|
|Abstract:||Objective: This study focuses on the potential impact of genome-based technologies on health care. Asthma in children was chosen as a case study and gene screening as the technology assessed to explore the cost-effectiveness of applying early genetic screening to newborns and preventive treatment to the population at risk. Early intervention could prevent progression and facilitate clinical management of the disease. From the elite group of genetic markers that have been associated with asthma-related phenotypes, ADAM33 was the first published candidate gene detected by a positional cloning approach, marking the entry of asthma research into the genomic era. The model was therefore initially set for an ex-ante analysis of the cost-effectiveness of applying the preventive programme to all the population presenting the ADAM33 genetic marker, with the idea of expanding to further markers and their combinations later on. Methods: According to the US NIH, Heart Lung and Blood Institute, four categories of asthma are considered. A Markov model consisting of six mutually exclusive disease states (including healthy and dead states) with a simulation horizon of 100 years was constructed, being the cycle length 1 year. Two different scenarios were defined. In scenario 1 genetic screening and preventive treatment are applied to all the population having the genetic marker and during the risk window from 0 to 6 years. In scenario 2 early genetic screening is applied to all newborns but preventive treatment only to children who present both wheezing and the genetic marker. The CEA was performed from third party payer and patient perspective after year 6. Conclusions: The cost-effectiveness of early genetic screening and of applying the preventive strategy to all the population presenting the selected ADAM33 marker remains on the borderline of cost-effectiveness. Nevertheless early genetic screening plus preventive treatment of all children with both wheezing and presenting the susceptibility genetic marker seems to be cost-effective. The model is a valuable tool for the ex-ante assessment of the cost-effectiveness of preventive schemes based on genetic screening. The value of modelling prior to clinical trials lies in informing study design and in setting priorities for future research.|
|JRC Institute:||Institute for Prospective Technological Studies|
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