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Li C, Vandersluis S, Holubowich C, Ungar WJ, Goh ES, Boycott KM, Sikich N, Dhalla I, Ng V. Correspondence on "cost or price of sequencing? implications for economic evaluations in genomic medicine" by Grosse and Gudgeon. Genet Med 2021; 24:251-252. [PMID: 34906460 DOI: 10.1016/j.gim.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Chunmei Li
- Ontario Health (Quality), Toronto, Ontario, Canada.
| | | | | | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute (CHEO), University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy Sikich
- Ontario Health (Quality), Toronto, Ontario, Canada
| | - Irfan Dhalla
- Ontario Health (Quality), Toronto, Ontario, Canada; Unity Health Toronto, Toronto, Ontario, Canada
| | - Vivian Ng
- Ontario Health (Quality), Toronto, Ontario, Canada
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Li C, Vandersluis S, Holubowich C, Ungar WJ, Goh ES, Boycott KM, Sikich N, Dhalla I, Ng V. Cost-effectiveness of genome-wide sequencing for unexplained developmental disabilities and multiple congenital anomalies. Genet Med 2020; 23:451-460. [PMID: 33110268 DOI: 10.1038/s41436-020-01012-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Genetic testing is routine practice for individuals with unexplained developmental disabilities and multiple congenital anomalies. However, current testing pathways can be costly and time consuming, and the diagnostic yield low. Genome-wide sequencing, including exome sequencing (ES) and genome sequencing (GS), can improve diagnosis, but at a higher cost. This study aimed to assess the cost-effectiveness of genome-wide sequencing in Ontario, Canada. METHODS A cost-effectiveness analysis was conducted using a discrete event simulation from a public payer perspective. Six strategies involving ES or GS were compared. Outcomes reported were direct medical costs, number of molecular diagnoses, number of positive findings, and number of active treatment changes. RESULTS If ES was used as a second-tier test (after the current first-tier, chromosomal microarray, fails to provide a diagnosis), it would be less costly and more effective than standard testing (CAN$6357 [95% CI: 6179-6520] vs. CAN$8783 per patient [95% CI: 2309-31,123]). If ES was used after standard testing, it would cost an additional CAN$15,228 to identify the genetic diagnosis for one additional patient compared with standard testing. The results remained robust when parameters and assumptions were varied. CONCLUSION ES would likely be cost-saving if used earlier in the diagnostic pathway.
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Affiliation(s)
- Chunmei Li
- Ontario Health (Quality), Toronto, ON, Canada.
| | | | | | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Elaine S Goh
- Laboratory Medicine and Genetics, Trillium Health Partners, Mississauga, ON, Canada
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Irfan Dhalla
- Ontario Health (Quality), Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada
| | - Vivian Ng
- Ontario Health (Quality), Toronto, ON, Canada
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Xie X, Wang M, Goh ESY, Ungar WJ, Little J, Carroll JC, Okun N, Huang T, Rousseau F, Dougan SD, Tu HA, Higgins C, Holubowich C, Sikich N, Dhalla IA, Ng V. Noninvasive Prenatal Testing for Trisomies 21, 18, and 13, Sex Chromosome Aneuploidies, and Microdeletions in Average-Risk Pregnancies: A Cost-Effectiveness Analysis. J Obstet Gynaecol Can 2020; 42:740-749.e12. [PMID: 32008974 DOI: 10.1016/j.jogc.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The cost effectiveness of noninvasive prenatal testing (NIPT) has been established for high-risk pregnancies but remains unclear for pregnancies at other risk levels. The aim was to assess the cost effectiveness of NIPT in average-risk pregnancies from the perspective of a provincial public payer in Canada. METHODS A model was developed to compare traditional prenatal screening (TPS), NIPT as a second-tier test (performed only after a positive TPS result), and NIPT as a first-tier test (performed instead of TPS) for trisomies 21, 18, and 13; sex chromosome aneuploidies; and microdeletions in a hypothetical annual population cohort of average-risk pregnancies (142 000 to 148,000) in Ontario, Canada. A probabilistic analysis was conducted with 5000 repetitions. RESULTS Compared with TPS, NIPT as a second-tier test detected more affected fetuses with trisomies 21, 18, and 13 (188 vs. 158), substantially reduced the number of diagnostic tests (i.e., chorionic villus sampling and amniocentesis) performed (660 vs. 3107), and reduced the cost of prenatal screening ($26.7 million vs. $27.6 million) annually. Compared with second-tier NIPT, first-tier NIPT detected an additional 80 cases of trisomies 21, 18, and 13 at an additional cost of $33 million. The incremental cost per additional affected fetus detected was $412 411. Extending first-tier NIPT to include testing for sex chromosome aneuploidies and 22q11.2 deletion would increase the total screening cost. CONCLUSIONS NIPT as a second-tier test is cost-saving compared with TPS alone. Compared with second-tier NIPT, first-tier NIPT detects more cases of chromosomal anomalies but at a substantially higher cost.
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Affiliation(s)
| | | | - Elaine Suk-Ying Goh
- Laboratory Medicine and Genetics Program, Trillium Health Partners, Mississauga, ON
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - June C Carroll
- Department of Family and Community Medicine, Sinai Health System, University of Toronto, Toronto, ON
| | - Nan Okun
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON
| | - Tianhua Huang
- Prenatal Screening Ontario, Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON; Genetics Program, North York General Hospital, Toronto, ON
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec City, QC
| | - Shelley D Dougan
- Prenatal Screening Ontario, Better Outcomes Registry and Network (BORN) Ontario, Ottawa, ON
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