The Cost-Effectiveness of Maturity-Onset Diabetes of the Young Genetic Testing – Translating Genomic Advances into Practical Health Applications
- Rochelle N. Naylor, MD1,2⇑,
- Priya M. John, MPH3,
- Aaron N. Winn, MPP4,
- David Carmody, MD2,
- Siri Atma W. Greeley, MD, PHD1,2,
- Louis H. Philipson, MD, PHD1,2,
- Graeme I. Bell, PHD2 and
- Elbert S. Huang, MD, MPH5
- 1Department of Pediatrics, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois;
- 2Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois;
- 3Humana, Chicago, Illinois;
- 4Center for the Evaluation of Value and Risks in Health, Institute for Clinical Research and Health Policy, Tufts Medical Center, Boston, Massachusetts; and;
- 5Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, Illinois
- Corresponding author: Rochelle N Naylor, E-mail:
Objective To evaluate the cost-effectiveness of a genetic testing policy for HNF1A, HNF4A and GCK-MODY in a hypothetical cohort of type 2 diabetes patients 25-40 years old with a MODY prevalence of 2%.
Research Design and Methods We used a simulation model of type 2 diabetes complications based on UKPDS data, modified to account for the natural history of disease by genetic subtype, to compare a policy of genetic testing at diabetes diagnosis versus a policy of no testing. Under the screening policy, successful sulfonylurea treatment of HNF1A-MODY and HNF4A-MODY was modeled to produce a glycosylated hemoglobin reduction of -1.5%, compared to usual care. GCK-MODY received no therapy. Main outcome measures were costs and quality-adjusted life years (QALYs), based on lifetime risk of complications and treatments, expressed as the incremental cost-effectiveness ratio (ICER, $/QALY).
Results The testing policy yielded an average gain of 0.012 QALYs and resulted in an ICER of $205,000. Sensitivity analysis showed that if the MODY prevalence was 6%, the ICER would be ∼$50,000. If MODY prevalence was >30%, the testing policy was cost-saving. Reducing genetic testing costs to $700 also resulted in an ICER of ∼$50,000.
Conclusions Our simulated model suggests a policy of testing for MODY in selected populations is cost-effective for the United States based on contemporary ICER thresholds. Higher prevalence of MODY in the tested population or decreased testing costs would enhance cost-effectiveness. Our results make a compelling argument for routine coverage of genetic testing in patients with high clinical suspicion of MODY.
- Received February 19, 2013.
- Accepted September 3, 2013.
- © 2013 by the American Diabetes Association.
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