Cost-effectiveness of different population screening strategies for hereditary haemochromatosis in Australia

Barbara de Graaff, Amanda Neil, Lei Si, Kwang Chien Yee, Kristy Sanderson, Lyle Gurrin, Andrew J. Palmer

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Amongst populations of northern European ancestry, HFE-associated haemochromatosis is a common genetic disorder characterised by iron overload. In the absence of treatment, excess iron is stored in parenchymal tissues, causing morbidity and mortality. Population screening programmes may increase early diagnosis and reduce associated disease. No contemporary health economic evaluation has been published for Australia. The objective of this study was to identify cost-effective screening strategies for haemochromatosis in the Australian setting. Methods: A Markov model using probabilistic decision analysis was developed comparing four adult screening strategies: the status quo (cascade and incidental screening), genotyping with blood and buccal samples and transferrin saturation followed by genotyping (TfS). Target populations were males (30 years) and females (45 years) of northern European ancestry. Cost-effectiveness was estimated from the government perspective over a lifetime horizon. Results: All strategies for males were cost-effective compared to the status quo. The incremental costs (standard deviation) associated with genotyping (blood) were AUD7 (56), TfS AUD15 (45) and genotyping (buccal) AUD63 (56), producing ICERs of AUD1673, 4103 and 15,233/quality-adjusted life-year (QALY) gained, respectively. For females, only the TfS strategy was cost-effective, producing an ICER of AUD10,195/QALY gained. Approximately 3% of C282Y homozygotes were estimated to be identified with the status quo approach, compared with 40% with the proposed screening strategies. Conclusion: This model estimated that genotyping and TfS strategies are likely to be more cost-effective screening strategies than the status quo.

LanguageEnglish
Pages521-534
Number of pages14
JournalApplied Health Economics and Health Policy
Volume15
Issue number4
DOIs
Publication statusPublished - 1 Aug 2017
Externally publishedYes

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Hemochromatosis
Cost-Benefit Analysis
Costs and Cost Analysis
Quality-Adjusted Life Years
Cheek
Population
Inborn Genetic Diseases
Iron Overload
Population Control
Decision Support Techniques
Health Services Needs and Demand
Homozygote
Statistical Models
Transferrin
Early Diagnosis
Iron
Screening
Cost-effectiveness
Morbidity
Mortality

Cite this

de Graaff, Barbara ; Neil, Amanda ; Si, Lei ; Yee, Kwang Chien ; Sanderson, Kristy ; Gurrin, Lyle ; Palmer, Andrew J. / Cost-effectiveness of different population screening strategies for hereditary haemochromatosis in Australia. In: Applied Health Economics and Health Policy. 2017 ; Vol. 15, No. 4. pp. 521-534.
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abstract = "Introduction: Amongst populations of northern European ancestry, HFE-associated haemochromatosis is a common genetic disorder characterised by iron overload. In the absence of treatment, excess iron is stored in parenchymal tissues, causing morbidity and mortality. Population screening programmes may increase early diagnosis and reduce associated disease. No contemporary health economic evaluation has been published for Australia. The objective of this study was to identify cost-effective screening strategies for haemochromatosis in the Australian setting. Methods: A Markov model using probabilistic decision analysis was developed comparing four adult screening strategies: the status quo (cascade and incidental screening), genotyping with blood and buccal samples and transferrin saturation followed by genotyping (TfS). Target populations were males (30 years) and females (45 years) of northern European ancestry. Cost-effectiveness was estimated from the government perspective over a lifetime horizon. Results: All strategies for males were cost-effective compared to the status quo. The incremental costs (standard deviation) associated with genotyping (blood) were AUD7 (56), TfS AUD15 (45) and genotyping (buccal) AUD63 (56), producing ICERs of AUD1673, 4103 and 15,233/quality-adjusted life-year (QALY) gained, respectively. For females, only the TfS strategy was cost-effective, producing an ICER of AUD10,195/QALY gained. Approximately 3{\%} of C282Y homozygotes were estimated to be identified with the status quo approach, compared with 40{\%} with the proposed screening strategies. Conclusion: This model estimated that genotyping and TfS strategies are likely to be more cost-effective screening strategies than the status quo.",
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Cost-effectiveness of different population screening strategies for hereditary haemochromatosis in Australia. / de Graaff, Barbara; Neil, Amanda; Si, Lei; Yee, Kwang Chien; Sanderson, Kristy; Gurrin, Lyle; Palmer, Andrew J.

In: Applied Health Economics and Health Policy, Vol. 15, No. 4, 01.08.2017, p. 521-534.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-effectiveness of different population screening strategies for hereditary haemochromatosis in Australia

AU - de Graaff, Barbara

AU - Neil, Amanda

AU - Si, Lei

AU - Yee, Kwang Chien

AU - Sanderson, Kristy

AU - Gurrin, Lyle

AU - Palmer, Andrew J.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Introduction: Amongst populations of northern European ancestry, HFE-associated haemochromatosis is a common genetic disorder characterised by iron overload. In the absence of treatment, excess iron is stored in parenchymal tissues, causing morbidity and mortality. Population screening programmes may increase early diagnosis and reduce associated disease. No contemporary health economic evaluation has been published for Australia. The objective of this study was to identify cost-effective screening strategies for haemochromatosis in the Australian setting. Methods: A Markov model using probabilistic decision analysis was developed comparing four adult screening strategies: the status quo (cascade and incidental screening), genotyping with blood and buccal samples and transferrin saturation followed by genotyping (TfS). Target populations were males (30 years) and females (45 years) of northern European ancestry. Cost-effectiveness was estimated from the government perspective over a lifetime horizon. Results: All strategies for males were cost-effective compared to the status quo. The incremental costs (standard deviation) associated with genotyping (blood) were AUD7 (56), TfS AUD15 (45) and genotyping (buccal) AUD63 (56), producing ICERs of AUD1673, 4103 and 15,233/quality-adjusted life-year (QALY) gained, respectively. For females, only the TfS strategy was cost-effective, producing an ICER of AUD10,195/QALY gained. Approximately 3% of C282Y homozygotes were estimated to be identified with the status quo approach, compared with 40% with the proposed screening strategies. Conclusion: This model estimated that genotyping and TfS strategies are likely to be more cost-effective screening strategies than the status quo.

AB - Introduction: Amongst populations of northern European ancestry, HFE-associated haemochromatosis is a common genetic disorder characterised by iron overload. In the absence of treatment, excess iron is stored in parenchymal tissues, causing morbidity and mortality. Population screening programmes may increase early diagnosis and reduce associated disease. No contemporary health economic evaluation has been published for Australia. The objective of this study was to identify cost-effective screening strategies for haemochromatosis in the Australian setting. Methods: A Markov model using probabilistic decision analysis was developed comparing four adult screening strategies: the status quo (cascade and incidental screening), genotyping with blood and buccal samples and transferrin saturation followed by genotyping (TfS). Target populations were males (30 years) and females (45 years) of northern European ancestry. Cost-effectiveness was estimated from the government perspective over a lifetime horizon. Results: All strategies for males were cost-effective compared to the status quo. The incremental costs (standard deviation) associated with genotyping (blood) were AUD7 (56), TfS AUD15 (45) and genotyping (buccal) AUD63 (56), producing ICERs of AUD1673, 4103 and 15,233/quality-adjusted life-year (QALY) gained, respectively. For females, only the TfS strategy was cost-effective, producing an ICER of AUD10,195/QALY gained. Approximately 3% of C282Y homozygotes were estimated to be identified with the status quo approach, compared with 40% with the proposed screening strategies. Conclusion: This model estimated that genotyping and TfS strategies are likely to be more cost-effective screening strategies than the status quo.

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