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Yin GS, Shao Z, Faghfoury H, Ballios BG. Streamlined Ophthalmologist-Led Pathway to Diagnosis and Accessibility of Genetics Testing for Patients with Inherited Retinal Dystrophies in Canada. Ophthalmol Retina 2024:S2468-6530(24)00367-1. [PMID: 39154861 DOI: 10.1016/j.oret.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/28/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE To investigate the ability of a new clinical model to improve accessibility and expedite the pathway to molecular diagnosis for patients with suspected inherited retinal diseases (IRD). DESIGN Retrospective cohort study of electronic patient records. PARTICIPANTS All patients referred to general medical genetic clinic between September 2017 to September 2019 and an ophthalmologist-led IRD clinic between October 2021 to July 2023 for suspected IRD were included. METHODS The difference in timeliness and accessibility to diagnosis and genetics testing for patients referred for suspected IRDs were compared based on whether they were referred to general medical genetics clinic or an ophthalmologist-led IRD clinic. MAIN OUTCOME MEASURES The primary outcomes were time to consult from referral; time from initial consult to molecular diagnosis; and the time from initial consult to genetics result disclosure and counseling. Secondary outcomes included number of prior providers investigating the chief complaint; the proportion of patients undergoing genetics testing; and the range of diagnostic investigations undertaken. RESULTS 473 patients were included, with 212 cases from general medical genetics clinic and 261 from medical retina clinic. The mean time from referral to initial consult was 14 months (±3.33 months) and 4 months (±3.4 months) for general medical genetics and the ophthalmologist-led IRD clinic respectively. The mean time from initial consult to genetics disclosure and counselling was 6 months (±3.6 months) and 3.5 months (±1.8 months) for medical genetics and the ophthalmologist-led model respectively. The total time from initial referral to genetics disclosure and counselling for the medical geneticist-led clinic model was 20-24 months. The total time from initial referral to genetics disclosure and counselling for ophthalmologist-led retinal clinic was 5-8 months. The average number of prior providers seen prior to presenting to ophthalmologist-led retina clinic was 2.05 (range 1-10). CONCLUSIONS Shifting from the traditional medical genetics model to the new ophthalmologist-led IRD clinical model may improve accessibility and expedite the pathway to molecular diagnosis and subsequent gene therapy trials for patients with suspected IRDs.
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Affiliation(s)
- Grace S Yin
- Queen's University School of Medicine, Queen's University, ON, Canada; Department of Ophthalmology and Vision Science, University of Toronto, ON, Canada
| | - Zhuo Shao
- Genetics Program, North York General Hospital, University of Toronto, ON, Canada
| | - Hanna Faghfoury
- Fred A. Litwin and Family Center in Genetic Medicine, Department of Medicine, University of Toronto, ON, Canada
| | - Brian G Ballios
- Department of Ophthalmology and Vision Science, University of Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Kensington Vision & Research Centre, Kensington Health, Toronto, ON, Canada
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Ng QX, Ong C, Yaow CYL, Chan HW, Thumboo J, Wang Y, Koh GCH. Cost-of-illness studies of inherited retinal diseases: a systematic review. Orphanet J Rare Dis 2024; 19:93. [PMID: 38424595 PMCID: PMC10905859 DOI: 10.1186/s13023-024-03099-9] [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: 12/18/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND While health care and societal costs are routinely modelled for most diseases, there is a paucity of comprehensive data and cost-of-illness (COI) studies for inherited retinal diseases (IRDs). This lack of data can lead to underfunding or misallocation of resources. A comprehensive understanding of the COI of IRDs would assist governmental and healthcare leaders in determining optimal resource allocation, prioritizing funding for research, treatment, and support services for these patients. METHODS Following PRISMA guidelines, a literature search was conducted using Medline, EMBASE and Cochrane databases, from database inception up to 30 Jun 2023, to identify COI studies related to IRD. Original studies in English, primarily including patients with IRDs, and whose main study objective was the estimation of the costs of IRDs and had sufficiently detailed methodology to assess study quality were eligible for inclusion. To enable comparison across countries and studies, all annual costs were standardized to US dollars, adjusted for inflation to reflect their current value and recalculated on a "per patient" basis wherever possible. The review protocol was registered in PROSPERO (registration number CRD42023452986). RESULTS A total of nine studies were included in the final stage of systematic review and they consistently demonstrated a significant disease burden associated with IRDs. In Singapore, the mean total cost per patient was roughly US$6926/year. In Japan, the mean total cost per patient was US$20,833/year. In the UK, the mean total cost per patient with IRD ranged from US$21,658 to US$36,549/year. In contrast, in the US, the mean total per-patient costs for IRDs ranged from about US$33,017 to US$186,051 per year. In Canada, these mean total per-patient costs varied between US$16,470 and US$275,045/year. Non-health costs constituted the overwhelming majority of costs as compared to healthcare costs; 87-98% of the total costs were due to non-health costs, which could be attributed to diminished quality of life, poverty, and increased informal caregiving needs for affected individuals. CONCLUSION IRDs impose a disproportionate societal burden outside health systems. It is vital for continued funding into IRD research, and governments should incorporate societal costs in the evaluation of cost-effectiveness for forthcoming IRD interventions, including genomic testing and targeted therapies.
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Affiliation(s)
- Qin Xiang Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore.
| | - Clarence Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Clyve Yu Leon Yaow
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwei Wuen Chan
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Gerald Choon Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Bottazzi L, Antropoli A, Bianco L, Andrao A, Galimberti G, Mascetti S, Arrigo A, Saladino A, Bandello F, Parodi MB. Understanding the propensity to undergo genetic testing in patients affected by inherited retinal diseases: a twelve-item questionnaire. Ophthalmic Genet 2023; 44:49-53. [PMID: 36239612 DOI: 10.1080/13816810.2022.2135111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The diagnosis of inherited retinal diseases (IRDs) can only be confirmed through genetic testing. The aim of our study is to investigate the propensity of Italian patients affected by IRDs to undergo genetic testing. MATERIALS AND METHODS One hundred and thirty-two patients diagnosed with IRDs referred to Italian Retina Onlus were enrolled from 1st January 2021 to 31th December 2021 in this cross-sectional study to answer to a twelve-item questionnaire. RESULTS One hundred and four patients were aware of the possibility of taking a genetic test, and 94 of them did. Most of genetically tested patients (93.6%) had been informed about advantages and limitations of genetic investigations. The most common reason for undergoing genetic testing was to gather information for their relatives, while the most frequent reason for patients not taking the test was lack of someone who encourages them to do so. Most of genetically tested patients believed that the results could aid medical research in the search for a treatment for IRDs, while who did not undergo DNA testing often did not have a clear opinion on the topic. Almost all patients (98.9%) performed the test through the Italian National Health System. CONCLUSIONS Our study investigated the tendency of Italian patients affected by IRDs to undergo genetic testing, highlighting the importance of educating both patients and healthcare professionals on this topic.
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Affiliation(s)
- Leonardo Bottazzi
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Antropoli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Bianco
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Gabriele Galimberti
- Retina Italia Onlus Association, Milan, Italy.,Università degli studi di Milano, Milan, Italy
| | | | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Saladino
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Simonelli F, Sodi A, Falsini B, Bacci G, Iarossi G, Di Iorio V, Giorgio D, Placidi G, Andrao A, Reale L, Fiorencis A, Aoun M. Narrative medicine to investigate the quality of life and emotional impact of inherited retinal disorders through the perspectives of patients, caregivers and clinicians: an Italian multicentre project. BMJ Open 2022; 12:e061080. [PMID: 36123082 PMCID: PMC9486281 DOI: 10.1136/bmjopen-2022-061080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Although inherited retinal disorders (IRDs) related to the gene encoding the retinal pigment epithelium 65kD protein (RPE65) significantly impact the vision-related quality of life (VRQoL), their emotional and social aspects remain poorly investigated in Italy. Narrative Medicine (NM) reveals the more intimate aspects of the illness experience, providing insights into clinical practice. DESIGN AND SETTING This NM project was conducted in Italy between July and December 2020 and involved five eye clinics specialised in IRDs. Illness plots and parallel charts, together with a sociodemographic survey, were collected through the project's website; remote in-depth interviews were also conducted. Narratives and interviews were analysed through NVivo software and interpretive coding. PARTICIPANTS 3 paediatric and 5 adult patients and eight caregivers participated in the project; 11 retinologists globally wrote 27 parallel charts; 5 professionals from hospital-based multidisciplinary teams and one patient association member were interviewed. RESULTS Findings confirmed that RPE65-related IRDs impact VRQoL in terms of activities and mobility limitations. The emotional aspects emerged as crucial in the clinical encounter and as informative on IRD management challenges and real-life experiences, while psychological support was addressed as critical from clinical diagnosis throughout the care pathway for both patients and caregivers; the need for an IRDs 'culture' emerged to acknowledge these conditions, and therefore, promoting diversity within society. CONCLUSIONS The project was the first effort to investigate the impact of RPE65-related IRDs on the illness experience through NM, concomitantly addressing the perspectives of paediatric and adult patients, caregivers and healthcare professionals and provided preliminary insights for the knowledge of RPE65-related IRDs and the clinical practice.
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Affiliation(s)
- Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "L. Vanvitelli, Naples, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Benedetto Falsini
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giacomo Bacci
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Giancarlo Iarossi
- Ophthalmology Department, Bambino Gesù IRCCS Pediatric Hospital, Rome, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "L. Vanvitelli, Naples, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Giorgio Placidi
- UOC Oftalmologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Ferraz Sallum JM, Godoy J, Kondo A, Kutner JM, Vasconcelos H, Maia A. The first gene therapy for RPE65 biallelic dystrophy with voretigene neparvovec-rzyl in Brazil. Ophthalmic Genet 2022; 43:550-554. [PMID: 35416119 DOI: 10.1080/13816810.2022.2053995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the first Brazilian patient with RPE65 deficiency-inherited retinal dystrophy (RPE65-IRD) treated with voretigene neparvovec-rzyl (VN). METHODS An adult patient with Leber congenital amaurosis-2 with a homozygous mutation in the RPE65 gene (p.Phe83Leu) was treated bilaterally with VN. The clinical and surgical aspects are described. The baseline and 4-month postoperative ophthalmologic examinations included measurement of the best-corrected visual acuity (BCVA), full-field stimulus threshold (FST) test, Octopus 900 semiautomated kinetic visual fields (VFs), and microperimetry. RESULTS No complications developed in this patient. The BCVA remained stable. The full-field stimulus threshold test (FST) and VFs showed clinically significant improvements bilaterally. The patient reported significant improvements in the ability to perform daily activities, mainly for those requiring the VFs and vision in a low-luminescence environment. CONCLUSIONS The treatments were beneficial for this patient who was homozygous for RPE65 p.Phe83Leu. The first VN treatments in an adult Brazilian patient in clinical practice showed measurable improvements in visual outcomes that were meaningful for the patient's daily activities. TRANSLATIONAL RELEVANCE This case reinforces the clinical trial results and proves that the procedure is feasible in countries such as Brazil.
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Affiliation(s)
| | - Juliana Godoy
- Blood Bank Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andrea Kondo
- Blood Bank Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Andre Maia
- Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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