Table A38:
Scenario Analyses for PGx Versus TAU
| Scenario Analyses | PGx vs. TAU: ICER ($/QALY)a,b; INB > or < 0 ($)a,b; Δ C ($); Δ E (QALY) |
|---|---|
| Reference Case Analysis c | |
| Time horizon: 1 y | ICER: 60,564; INB < 0; Δ C = $1,906; Δ E = 0.031 |
| Time horizon c,d | |
| 6 mo (vs. 1 y in reference case); RR of relapse = 0.39 6 mo; RR of relapse = 1 |
ICER: 185,993; INB < 0; Δ C = $2,392; Δ E = 0.013 ICER: 221,284; INB < 0; Δ C = $2,421; Δ E = 0.011 |
| 2 y; RR of relapse = 0.39 2 y; RR of relapse = 1 |
ICER: 14,373; INB > 0; Δ C = $959; Δ E = 0.067 ICER: 23,800; INB > 0; Δ C = $1,273; Δ E = 0.053 |
| 3 y; RR of relapse = 0.39 3 y; RR of relapse = 1 |
ICER: 244; INB > 0; Δ C = $25; Δ E = 0.102 ICER: 6,375; INB > 0; Δ C = $521; Δ E = 0.082 |
| 5 y; RR of relapse = 0.39 5 y; RR of relapse = 1 |
ICER: Dominant; INB > 0; Δ C = –$1,788; Δ E = 0.171 ICER: Dominant; INB > 0; Δ C = –$937; Δ E = 0.137 |
| Well Health State c | |
| Addition of well state, time horizon = 1 y, RR of relapse = 0.39 | ICER: 59,329; INB < 0; Δ C = 1,898; Δ E = 0.032 |
| Addition of well state, time horizon = 1 y, RR of relapse = 1 | ICER: 79,811; INB < 0; Δ C = 2,029; Δ E = 0.025 |
| Analytic Perspective c | |
| Inclusion of direct non-medical costs to the government (vs. solely direct medical costs in reference case); time horizon = 1 y | ICER: 57,155; INB < 0; Δ C = 1,799; Δ E = 0.031 |
| Inclusion of disability-related costs in addition to direct non-medical costs | ICER: 56,230; INB < 0; Δ C = 1,770; Δ E = 0.031 |
| Societal perspective (all direct and indirect costs) | ICER: 48,424; INB < 0; Δ C = 1,524; Δ E = 0.031 |
Abbreviations: Δ E, incremental effects; Δ C, incremental costs; ICER, incremental cost-effectiveness ratio; INB, incremental net benefit; PGx, multi-gene pharmacogenomic-guided treatment that includes a decision support tool; QALY, quality-adjusted life-year; RCT, randomized controlled trial; RR, risk ratio; TAU, treatment as usual.
All costs are in 2020 Canadian dollars.
ICER = Δ C ÷ Δ E and INB = Δ E × $50,000/QALY – Δ C; if INB ($) > 0, then the strategy is cost-effective at a willingness-to-pay amount of $50,000/QALY gained; otherwise, the strategy (PGx) is not cost-effective. Dominant strategy means that PGx intervention is associated with lower costs and greater QALYs. Negative incremental costs indicate savings. If PGx was dominated, this means that TAU was associated with lower costs and greater effects. Changes in Δ C or Δ E might not be obvious owing to rounding.
Probabilistic analyses included 10,000 simulations.
Costs and effectiveness were not discounted at 1.5% in the reference case and short-term scenarios; but discounting was applied in long-term scenarios assuming time horizon > 1 y.