Cost-effectiveness of polygenic risk profiling for primary open-angle glaucoma in the United Kingdom and Australia

Abstract

Purpose : Primary open-angle glaucoma (POAG) is the most common subtype of glaucoma worldwide. We evaluate the cost-effectiveness of polygenic risk score (PRS) profiling as a screening tool for POAG.

Methods : We used a Markov cohort model to evaluate the cost-effectiveness of implementing polygenic risk profiling as a new POAG-screening approach in the UK and Australia. Six health states were included in this model: death, early, mild, moderate, severe, and healthy individuals. The evaluation was conducted from the healthcare payer’s perspective. We used the best available published data to calculate prevalence, transition probabilities, utility and other parameters for each health state and age group. The study followed the Consolidated Health Economic Evaluation Reporting Standards checklist. Our main outcome measure was the incremental cost-effectiveness ratio (ICER) and secondary outcomes were years of blindness avoided per person and a ‘Blindness ICER’. We did one-way and two-way deterministic and probabilistic sensitivity analyses to reflect the uncertainty around predicting ICERs.

Results : Our proposed genetic screening programme for POAG in Australia is predicted to result in ICER of AU$34,252 (95% CI AU$21,324-95,497) and would avoid 1 year of blindness at ICER of AU$13,359 (95% CI: AU$8,143-37,448). In the UK, this screening is predicted to result in ICER of £24,783 (13,373-66,960) and would avoid 1 year of blindness at ICER of £10,095 (95%CI: £5,513-27,656). Using the willingness to pay thresholds of $54,808 and £30,000, the proposed screening model is 79.2% likely to be cost-effective in Australia and is 60.2% likely to be cost-effective in the UK, respectively.

Conclusions : Although the level of willingness to pay for Australian Government is uncertain, and the ICER range for the UK is broad, we showed a clear target strategy for early detection and prevention of advanced POAG in these developed countries.

This is a 2021 ARVO Annual Meeting abstract.

 

Cost-effectiveness acceptability curve for the genetic screening programme. The probability that the screening programme is cost-effective at different willingness to pay (WTP) thresholds for the UK model.

 

Cost-effectiveness acceptability curve for the genetic screening programme. The probability that the screening programme is cost-effective at different willingness to pay (WTP) thresholds for the Australia model.