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Neves LM, Pinto M, Zin OA, Cunha DP, Agonigi BNS, Motta FL, Gomes LHF, Horovitz DDG, Almeida DC, Malacarne J, Guida L, Braga A, Carvalho AB, Pereira E, Rodrigues APS, Sallum JMF, Zin AA, Vasconcelos ZFM. The cost of genetic diagnosis of suspected hereditary pediatric cataracts with whole-exome sequencing from a middle-income country perspective: a mixed costing analysis. J Community Genet 2024; 15:235-247. [PMID: 38730191 PMCID: PMC11217199 DOI: 10.1007/s12687-024-00708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
Up to 25% of pediatric cataract cases are inherited. There is sparse information in the literature regarding the cost of whole-exome sequencing (WES) for suspected hereditary pediatric cataracts. Molecular diagnosis of suspected hereditary pediatric cataracts is important for comprehensive genetic counseling. We performed a partial economic evaluation with a mixed costing analysis, using reimbursement data and microcosting approach with a bottom-up technique to estimate the cost of using WES for genetic diagnosis of suspected hereditary pediatric cataracts from the perspective of the Brazilian governmental health care system. One hundred and ten participants from twenty-nine families in Rio de Janeiro (RJ) were included. Costs of consumables, staff and equipment were calculated. Two scenarios were created: (1) The reference scenario included patients from RJ with suspected hereditary pediatric cataracts plus two family members. (2) The alternative scenario considered other genetic diseases, resulting in 5,280 exams per month. Sensitivity analysis was also performed. In the reference scenario, the total cost per exam was 700.09 United States dollars (USD), and in the alternative scenario, the total cost was 559.23 USD. The cost of WES alone was 527.85 USD in the reference scenario and 386.98 USD in the alternative scenario. Sensitivity analysis revealed that the largest costs were associated with consumables in both scenarios. Economic evaluations can help inform policy decisions, especially in middle-income countries such as Brazil.
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Affiliation(s)
- Luiza M Neves
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
- Department of Ophthalmology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Márcia Pinto
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil.
| | - Olivia A Zin
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
- Instituto Brasileiro de Oftalmologia, Rio de Janeiro, 22250-040, Brazil
| | - Daniela P Cunha
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Bruna N S Agonigi
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | | | - Leonardo H F Gomes
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Dafne D G Horovitz
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Daltro C Almeida
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Jocieli Malacarne
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Leticia Guida
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
| | - Andressa Braga
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
| | - Adriana Bastos Carvalho
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-971, Brazil
| | | | - Ana Paula S Rodrigues
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
| | - Juliana M F Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, São Paulo, 04039-032, Brazil
- Instituto Nacional de Cardiologia, Rio de Janeiro, 22240-006, Brazil
| | - Andrea A Zin
- Instituto Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, 22250-020, Brazil
- Instituto Brasileiro de Oftalmologia, Rio de Janeiro, 22250-040, Brazil
- Instituto Catarata Infantil, Rio de Janeiro, 22250-040, Brazil
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Mordaunt DA, Gonzalez FS, Lunke S, Eggers S, Sadedin S, Chong B, Dalziel K, Stark Z, Goranitis I. The cost of proband and trio exome and genome analysis in rare disease: A micro-costing study. Genet Med 2024; 26:101058. [PMID: 38164890 DOI: 10.1016/j.gim.2023.101058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE Rare disease genomic testing is a complex process involving various resources. Accurate resource estimation is required for informed prioritization and reimbursement decisions. This study aims to analyze the costs and cost drivers of clinical genomic testing. METHODS Based on genomic sequencing workflows we microcosted limited virtual panel analysis on exome sequencing backbone, proband and trio exome, and genome testing for proband and trio analysis in 2023 Australian Dollars ($). Deterministic and probabilistic sensitivity analyses were undertaken. RESULTS Panel testing costs AUD $2373 ($733-$6166), and exome sequencing costs $2823 ($802-$7206) and $5670 ($2006-$11,539) for proband and trio analysis, respectively. Genome sequencing costs $4840 ($2153-$9890) and $11,589 ($5842-$16,562) for proband and trio analysis. The most expensive cost component of genomic testing was sequencing (36.9%-69.4% of total cost), with labor accounting for 27.1%-63.2% of total cost. CONCLUSION We provide a comprehensive analysis of rare disease genomic testing costs, for a range of clinical testing types and contexts. This information will accurately inform economic evaluations of rare disease genomic testing and decision making on policy settings that assist with implementation, such as genomic testing reimbursement.
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Affiliation(s)
- Dylan A Mordaunt
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia
| | - Francisco Santos Gonzalez
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia
| | - Sebastian Lunke
- Murdoch Children's Research Institute, Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia; Australian Genomics Health Alliance, Melbourne, Australia; Department of Pathology. University of Melbourne, Australia
| | - Stefanie Eggers
- Murdoch Children's Research Institute, Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia
| | - Simon Sadedin
- Murdoch Children's Research Institute, Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia
| | - Belinda Chong
- Murdoch Children's Research Institute, Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Zornitza Stark
- Department of Paediatrics, University of Melbourne, Australia; Women's and Children's Division, Southern Adelaide Local Health Network, Australia; Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ilias Goranitis
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Australian Genomics Health Alliance, Melbourne, Australia.
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