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Mallawaarachchi A, Biros E, Harris T, Bennetts B, Boughtwood T, Elliott J, Fowles L, Gardos R, Garza D, Goranitis I, Haas M, Huntley V, Jefferis J, Kassahn K, Leaver A, Lundie B, Lunke S, O'Connor C, Pratt G, Quinlan C, Shearman D, Soraru J, Sundaram M, Tchan M, Valente G, White J, Wilkins E, Alexander SI, Amir N, Best S, Gul H, Jayasinghe K, McCarthy H, Patel C, Stark Z, Mallett AJ. Shaping the future of kidney genetics in Australia: proceedings from the KidGen policy implementation workshop 2023. Hum Genomics 2024; 18:88. [PMID: 39154021 PMCID: PMC11330018 DOI: 10.1186/s40246-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
The KidGen Collaborative's Policy Implementation Workshop 2023 celebrated the 10th anniversary of Australia's first kidney genetics clinic in Brisbane. This event marked the establishment of a national network now comprising 19 kidney genetics clinics across Australia, all dedicated to providing equitable access to genomic testing for families affected by genetic kidney diseases. The workshop reflected on past progress and outlined future objectives for kidney genetics in Australia, recognising the collaborative efforts of clinical teams, researchers, and patients. Key insights from the workshop are documented in the proceedings.
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Affiliation(s)
- Amali Mallawaarachchi
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Erik Biros
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Townsville, QLD, Australia
| | - Trudie Harris
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Townsville, QLD, Australia
| | - Bruce Bennetts
- Department of Molecular Genetics, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Lindsay Fowles
- Pathology Queensland, Genetic Testing Stewardship Service, Brisbane, QLD, Australia
| | | | | | - Ilias Goranitis
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Economics Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - Matilda Haas
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | - Vanessa Huntley
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Karin Kassahn
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, South Australia, Australia
| | | | - Ben Lundie
- Pathology Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Caitlin O'Connor
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Greg Pratt
- Central Queensland University, Brisbane, QLD, Australia
| | - Catherine Quinlan
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Department of Nephrology, Royal Children's Hospital, Melbourne, VIC, Australia
- Kidney Regeneration, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Melbourne Genomics Health Alliance, Melbourne, VIC, Australia
| | | | - Jacqueline Soraru
- Department of Nephrology and Hypertension, Perth Children's Hospital, Perth, WA, Australia
- Department of Nephrology and Renal Transplantation, Fiona Stanley Hospital, Perth, WA, Australia
| | | | | | | | - Julie White
- Office of Research and Innovation, Queensland Health, Brisbane, QLD, Australia
| | - Ella Wilkins
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Steve I Alexander
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Nephrology, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Noa Amir
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Best
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Hossai Gul
- University of Technology Sydney, Sydney, NSW, Australia
| | - Kushani Jayasinghe
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Hugh McCarthy
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Nephrology, Sydney Children's Hospital, Sydney, NSW, Australia
- School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chirag Patel
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Zornitza Stark
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Melbourne, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew J Mallett
- The KidGen Collaborative, Australian Genomics, Melbourne, VIC, Australia.
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia.
- Townsville Institute of Health Research and Innovation, Townsville University Hospital, Townsville, QLD, Australia.
- Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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Jayasinghe K, Biros E, Harris T, Wood A, O’Shea R, Hill L, Fowles L, Wardrop L, Shalhoub C, Hahn D, Rangan G, Kevin L, Tchan M, Snelling P, Sandow R, Sundaram M, Chaturvedi S, Trnka P, Faull R, Poplawski NK, Huntley V, Garza D, Wallis M, Jose M, Leaver A, Trainer AH, Wilkins EJ, White S, Elbaum Y, Prawer Y, Krzesinski E, Valente G, Winship I, Ryan J, Whitlam J, Nicholls K, West K, Donaldson L, Johnstone L, Lewit-Mendes M, Kerr PG, Bodek S, Chakera A, MacShane M, Mincham C, Stackpoole E, Willis F, Soraru J, Pachter N, Bennetts B, Forbes TA, Mallawaarachchi A, Quinlan C, Patel C, McCarthy H, Goranitis I, Best S, Alexander S, Stark Z, Mallett AJ. Implementation and Evaluation of a National Multidisciplinary Kidney Genetics Clinic Network Over 10 Years. Kidney Int Rep 2024; 9:2372-2385. [PMID: 39156154 PMCID: PMC11328548 DOI: 10.1016/j.ekir.2024.04.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Diagnostic genomic sequencing is the emerging standard of care in nephrology. There is a growing need to scale up the implementation of genomic diagnostics nationally to improve patient outcomes. Methods This pragmatic study provided genomic or genetic testing to patients with suspected monogenic kidney disease through a national network of kidney genetics clinics (KGCs). We sought to evaluate the experiences of implementing genomic diagnostics across Australia and associated diagnostic outcomes between 2013 and 2022. Results We successfully established and expanded a nationwide network of 20 clinics as of 2022; concurrently developing laboratory, research, and education programs to scale the clinical application of genomics in nephrology. We report on an Australian cohort of 1506 kidney patients, of whom 1322 received their test results. We assessed barriers to implementation in the nephrology context, and where possible, applied real-time solutions to improve clinical processes over 10 years. Conclusion Developing a multidisciplinary kidney genetics model across multiple health services nationally was highly successful. This model supported optimal care of individuals with monogenic kidney disease in an economically responsible way. It has continued to evolve with technological and service developments and is now set to scale further as genomic testing for kidney patients transitions to health care system funding.
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Affiliation(s)
- Kushani Jayasinghe
- Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Erik Biros
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Trudie Harris
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Alasdair Wood
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rosie O’Shea
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lauren Hill
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lindsay Fowles
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Louise Wardrop
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Carolyn Shalhoub
- Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Sydney, New South Wales, Australia
| | - Deirdre Hahn
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gopala Rangan
- Westmead Hospital, Sydney, New South Wales, Australia
- Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucy Kevin
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michel Tchan
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Paul Snelling
- The Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rhiannon Sandow
- The Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | - Peter Trnka
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Randall Faull
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Nicola K. Poplawski
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Vanessa Huntley
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Matthew Jose
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Anna Leaver
- Austin Hospital, Melbourne, Victoria, Australia
| | - Alison H. Trainer
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Ella J. Wilkins
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue White
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yoni Elbaum
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yael Prawer
- Monash Health, Melbourne, Victoria, Australia
- Monash Genetics, Monash Health, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Emma Krzesinski
- Monash Health, Melbourne, Victoria, Australia
- Monash Genetics, Monash Health, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | | | - Ingrid Winship
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Kathy Nicholls
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kirsty West
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Liz Donaldson
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lilian Johnstone
- Monash Health, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | | | | | - Simon Bodek
- Austin Hospital, Melbourne, Victoria, Australia
| | - Aron Chakera
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Mandi MacShane
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Elaine Stackpoole
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Fiona Stanley Hospital Perth, Western Australia, Australia
| | - Francis Willis
- Perth Children's Hospital, Perth, Western Australia, Australia
| | | | - Nick Pachter
- Fiona Stanley Hospital Perth, Western Australia, Australia
| | - Bruce Bennetts
- Department of Molecular Genetics, Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas A. Forbes
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Nephrology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Kidney Regeneration, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amali Mallawaarachchi
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Catherine Quinlan
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Nephrology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Kidney Regeneration, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Chirag Patel
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Illias Goranitis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Genomics, Melbourne, Victoria, Australia
| | - Stephanie Best
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia
| | - Stephen Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Department of Nephrology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
| | - Zornitza Stark
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Andrew J. Mallett
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville University Hospital, Townsville, Queensland, Australia
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Pan T, Wu Y, Buchanan J, Goranitis I. QALYs and rare diseases: exploring the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing for childhood and adult-onset rare genetic conditions in Australia. Health Qual Life Outcomes 2023; 21:132. [PMID: 38087302 PMCID: PMC10717517 DOI: 10.1186/s12955-023-02216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Genomic testing transforms the diagnosis and management of rare conditions. However, uncertainty exists on how to best measure genomic outcomes for informing healthcare priorities. Using the HTA-preferred method should be the starting point to improve the evidence-base. This study explores the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing across childhood and adult-onset genetic conditions. METHOD Self-reported patient-reported outcomes (PRO) were obtained from: primary caregivers of children with suspected neurodevelopmental disorders (NDs) or genetic kidney diseases (GKDs) (carers' own PRO), adults with suspected GKDs using SF-12v2; adults with suspected complex neurological disorders (CNDs) using EQ-5D-5L; and adults with dilated cardiomyopathy (DCM) using AQol-8D. Responsiveness was assessed using the standardised response mean effect-size based on diagnostic (having a confirmed genomic diagnosis), personal (usefulness of genomic information to individuals or families), and clinical (clinical usefulness of genomic information) utility anchors. RESULTS In total, 254 people completed PRO measures before genomic testing and after receiving results. For diagnostic utility, a nearly moderate positive effect size was identified by the AQoL-8D in adult DCM patients. Declines in physical health domains masked any improvements in mental or psychosocial domains in parents of children affected by NDs and adult CNDs and DCM patients with confirmed diagnosis. However, the magnitude of the changes was small and we did not find statistically significant evidence of these changes. No other responsiveness evidence related to diagnostic, clinical, and personal utility of genomic testing was identified. CONCLUSION Generic PRO measures may lack responsiveness to the diagnostic, clinical and personal outcomes of genomics, but further research is needed to establish their measurement properties and relevant evaluative space in the context of rare conditions. Expected declines in the physical health of people experiencing rare conditions may further challenge the conventional application of quality of life assessments.
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Affiliation(s)
- Tianxin Pan
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - You Wu
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - James Buchanan
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
- Health Economics and Policy Research Unit, Queen Mary University of London, London, United Kingdom
| | - Ilias Goranitis
- Economics of Genomics and Precision Medicine Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
- Australian Genomics Health Alliance, Melbourne, Victoria, Australia.
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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Wu Y, Jayasinghe K, Stark Z, Quinlan C, Patel C, McCarthy H, Mallawaarachchi AC, Kerr PG, Alexander S, Mallett AJ, Goranitis I. Genomic testing for suspected monogenic kidney disease in children and adults: A health economic evaluation. Genet Med 2023; 25:100942. [PMID: 37489581 DOI: 10.1016/j.gim.2023.100942] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE To assess the relative cost-effectiveness of genomic testing compared with standard non-genomic diagnostic investigations in patients with suspected monogenic kidney disease from an Australian health care system perspective. METHODS Diagnostic and clinical information was used from a national cohort of 349 participants. Simulation modelling captured diagnostic, health, and economic outcomes during a time horizon from clinical presentation until 3 months post-test results based on the outcome of cost per additional diagnosis and lifetime horizon based on cost per quality-adjusted life-year (QALY) gained. RESULTS Genomic testing was Australian dollars (AU$) 1600 more costly per patient and led to an additional 27 diagnoses out of a 100 individuals tested, resulting in an incremental cost-effectiveness ratio of AU$5991 per additional diagnosis. Using a lifetime horizon, genomic testing resulted in an additional cost of AU$438 and 0.04 QALYs gained per individual compared with standard diagnostic investigations, corresponding to an incremental cost-effectiveness ratio of AU$10,823 per QALY gained. Sub-group analyses identified that the results were largely driven by the cost-effectiveness in glomerular diseases. CONCLUSION Based on established or expected thresholds of cost-effectiveness, our evidence suggests that genomic testing is very likely to be cost saving for individuals with suspected glomerular diseases, whereas no evidence of cost-effectiveness was found for non-glomerular diseases.
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Affiliation(s)
- You Wu
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Australian Genomics Health Alliance, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kushani Jayasinghe
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Nephrology, Monash Medical Centre, Melbourne, Australia; Monash University, Melbourne, Australia; The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance, Melbourne, VIC, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Catherine Quinlan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Department of Pediatric Nephrology, Royal Children's Hospital, Melbourne, Australia
| | - Chirag Patel
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Australia; Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia; Sydney Children's Hospitals Network, Sydney, Australia; Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Amali C Mallawaarachchi
- Department of Medical Genetics, Royal Prince Alfred Hospital, Sydney, Australia; Garvan Institute of Medical Research, Sydney, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Stephen Alexander
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, Australia; Sydney Children's Hospitals Network, Sydney, Australia; Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Andrew J Mallett
- The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Australia; Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Renal Medicine, Townsville University Hospital, Townsville, Australia; College of Medicine & Dentistry, James Cook University, Townsville, Australia.
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Australian Genomics Health Alliance, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; The KidGen Collaborative, Australian Genomics Health Alliance, Melbourne, Australia.
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Soraru J, Jahan S, Quinlan C, Simons C, Wardrop L, O'Shea R, Wood A, Mallawaarachchi A, Patel C, Stark Z, Mallett AJ. The HIDDEN Protocol: An Australian Prospective Cohort Study to Determine the Utility of Whole Genome Sequencing in Kidney Failure of Unknown Aetiology. Front Med (Lausanne) 2022; 9:891223. [PMID: 35721054 PMCID: PMC9204488 DOI: 10.3389/fmed.2022.891223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Early identification of genetic kidney disease allows personalised management, clarification of risk for relatives, and guidance for family planning. Genetic disease is underdiagnosed, and recognition of genetic disease is particularly challenging in patients with kidney failure without distinguishing diagnostic features. To address this challenge, the primary aim of this study is to determine the proportion of genetic diagnoses amongst patients with kidney failure of unknown aetiology, using whole genome sequencing (WGS). A cohort of up to 100 Australian patients with kidney failure of unknown aetiology, with onset <50 years old and approved by a panel of study investigators will be recruited via 18 centres nationally. Clinically accredited WGS will be undertaken with analysis targeted to a priority list of ∼388 genes associated with genetic kidney disease. The primary outcome will be the proportion of patients who receive a molecular diagnosis (diagnostic rate) via WGS compared with usual -care (no further diagnostic investigation). Participant surveys will be undertaken at consent, after test result return and 1 year subsequently. Where there is no or an uncertain diagnosis, future research genomics will be considered to identify candidate genes and new pathogenic variants in known genes. All results will be relayed to participants via the recruiting clinician and/or kidney genetics clinic. The study is ethically approved (HREC/16/MH/251) with local site governance approvals in place. The future results of this study will be disseminated and inform practical understanding of the potential monogenic contribution to kidney failure of unknown aetiology. These findings are anticipated to impact clinical practice and healthcare policy.
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Affiliation(s)
- Jacqueline Soraru
- Department of Nephrology and Hypertension, Perth Children's Hospital, Perth, WA, Australia
| | - Sadia Jahan
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine Quinlan
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Cas Simons
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Louise Wardrop
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Rosie O'Shea
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Alasdair Wood
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Amali Mallawaarachchi
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Chirag Patel
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Zornitza Stark
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew John Mallett
- Faculty of Medicine, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.,Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Genetic Health Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Townsville University Hospital, Townsville, QLD, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Bekheirnia N, Glinton KE, Rossetti L, Manor J, Chen W, Lamb DJ, Braun MC, Bekheirnia MR. Clinical Utility of Genetic Testing in the Precision Diagnosis and Management of Pediatric Patients with Kidney and Urinary Tract Diseases. KIDNEY360 2021; 2:90-104. [PMID: 35368817 PMCID: PMC8785738 DOI: 10.34067/kid.0002272020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/29/2020] [Indexed: 02/04/2023]
Abstract
Background As genetic testing increasingly integrates into the practice of nephrology, our understanding of the basis of many kidney disorders has exponentially increased. Given this, we recently initiated a Renal Genetics Clinic (RGC) at our large, urban children's hospital for patients with kidney disorders. Methods Genetic testing was performed in Clinical Laboratory Improvement Amendments-certified laboratories using single gene testing, multigene panels, chromosomal microarray, or exome sequencing. Results A total of 192 patients were evaluated in this clinic, with cystic kidney disease (49/192) being the most common reason for referral, followed by congenital anomalies of the kidney and urinary tract (41/192) and hematuria (38/192). Genetic testing was performed for 158 patients, with an overall diagnostic yield of 81 out of 158 (51%). In the 16 out of 81 (20%) of patients who reached a genetic diagnosis, medical or surgical treatment of the patients were affected, and previous clinical diagnoses were changed to more accurate genetic diagnoses in 12 of 81 (15%) patients. Conclusions Our genetic testing provided an accurate diagnosis for children and, in some cases, led to further diagnoses in seemingly asymptomatic family members and changes to overall medical management. Genetic testing, as facilitated by such a specialized clinical setting, thus appears to have clear utility in the diagnosis and counseling of patients with a wide range of kidney manifestations.
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Affiliation(s)
- Nasim Bekheirnia
- Section of Pediatric Renal Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Kevin E. Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Linda Rossetti
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Joshua Manor
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Wuyan Chen
- PreventionGenetics Diagnostic Laboratory, Marshfield, Wisconsin
| | - Dolores J. Lamb
- Department of Urology, Englander Institute for Precision Medicine and Center for Reproductive Genomics, Weill Cornell Medicine, New York, New York
| | - Michael C. Braun
- Section of Pediatric Renal Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Mir Reza Bekheirnia
- Section of Pediatric Renal Disease, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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Attitudes and Practices of Australian Nephrologists Toward Implementation of Clinical Genomics. Kidney Int Rep 2020; 6:272-283. [PMID: 33615052 PMCID: PMC7879212 DOI: 10.1016/j.ekir.2020.10.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Genomic testing is becoming widely available as a diagnostic tool, although widespread implementation is not yet established in nephrology. Methods An anonymous electronic survey was administered to investigate experience and confidence with genomic tests, perceived clinical utility of genomic services, preferences for service delivery models, and readiness for implementation among nephrologists. Questions were guided by a comprehensive literature review and published tools, including a validated theoretical framework for implementation of genomic medicine: Consolidated Framework for Implementation Research (CFIR). Results Responses were received from 224 clinicians, of which 172 were eligible for analysis. Most clinicians (132 [76%]) had referred at least one patient to a genetics clinic. Despite most clinicians (136 [85%]) indicating that they believed genetic testing would be useful, only 39 (23%) indicated they felt confident to use results of genomic testing, with pediatric clinicians feeling more confident compared with adult clinicians (12 of 20 [60%] vs. 27 of 149 [18%]), P < 0.01, Fisher exact). A multidisciplinary renal genetics clinic was the preferred model among clinicians surveyed (98 of 172 [57%]). A key implementation barrier highlighted related to the hospital or organizational culture and/or environment. Specific barriers noted in quantitative and qualitative responses included inadequate staffing, learning resources, and funding. Conclusions Our findings suggest support for genomic testing among nephrologists, with a strong preference for a multidisciplinary model (involving a nephrologist, clinical geneticist, and genetic counselor). Broad-ranging interventions are urgently required to shift the current culture and ensure successful implementation of genomics in nephrology, including reducing knowledge gaps, increased funding and resources, disease-specific guidelines, and streamlining of testing processes.
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