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Genetic testing in combination with preventive donepezil treatment for patients with amnestic mild cognitive impairment: an exploratory economic evaluation of personalized medicine.

https://arctichealth.org/en/permalink/ahliterature118609
Source
Mol Diagn Ther. 2012 Dec;16(6):389-99
Publication Type
Article
Date
Dec-2012
Author
Sandjar Djalalov
Jean Yong
Jaclyn Beca
Sandra Black
Gustavo Saposnik
Zahra Musa
Katherine Siminovitch
Myla Moretti
Jeffrey S Hoch
Author Affiliation
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Source
Mol Diagn Ther. 2012 Dec;16(6):389-99
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Amnesia - complications - drug therapy - economics - genetics
Canada
Case-Control Studies
Chemoprevention - economics - methods
Cost-Benefit Analysis
Genetic Testing - economics - methods - utilization
Humans
Indans - economics - therapeutic use
Individualized Medicine - economics - methods
Markov Chains
Mild Cognitive Impairment - complications - drug therapy - economics - genetics
Molecular Targeted Therapy - economics - methods
Nootropic Agents - economics - therapeutic use
Piperidines - economics - therapeutic use
Quality-Adjusted Life Years
Severity of Illness Index
Standard of Care - economics
Abstract
To evaluate the cost effectiveness of genetic screening for the apolipoprotein (APOE) e4 allele in combination with preventive donepezil treatment in comparison with the standard of care for amnestic mild cognitive impairment (AMCI) patients in Canada.
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.
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.
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.
PubMed ID
23188525 View in PubMed
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Why should dentists screen for oral cancer?

https://arctichealth.org/en/permalink/ahliterature157903
Source
J Can Dent Assoc. 2008 Apr;74(3):243-4
Publication Type
Article
Date
Apr-2008
Author
Zahra Musa
Karissa Johnston
Stuart Peacock
Miriam P Rosin
J Mark Elwood
Author Affiliation
University of British Columbia and Centre for Health Economics in Cancer, BC Cancer Agency/Cancer Research Centre, Vancouver, British Columbia. zmusa@bccrc.ca
Source
J Can Dent Assoc. 2008 Apr;74(3):243-4
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Age Factors
Alcohol Drinking
British Columbia
Dentist's Practice Patterns
Early Diagnosis
Humans
Mass Screening
Mouth Neoplasms - diagnosis
Risk factors
Smoking
PubMed ID
18387265 View in PubMed
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