Exploratory Economic Evaluation of a Genome Precision Report in Kidney and Liver Transplantation Care
- Author(s)
- Sjaaf, F; Pang, L; Kuo, SFT; Vaz, K; Thompson, BA; Goranitis, I; Gaff, C; Martyn, M; James, P; Schilling, C; Melbourne Genomics Health Alliance Clinical Change Project;
- Journal Title
- Value in Health
- Publication Type
- Online publication before print
- Abstract
- OBJECTIVES: To investigate the impact of including four domains of kidney and liver transplantation care (tacrolimus optimisation, postoperative complications prevention, screening, familial testing) on the cost-effectiveness of a genome precision report, and identify key parameters driving the cost-effectiveness. METHODS: A decision tree model-based cost-utility analysis comparing a genome precision report with standard non-genomic practice from the Australian health care system perspective was conducted, using data from the literature (lifetime costs and quality-adjusted life-years [QALYs] discounted at 3-5 per cent, following the source studies) and the Clinical Change Project study. Costs were in 2024 Australian dollars (US dollar values converted using purchasing power parities). We conducted a stepped evaluation that sequentially added each domain, and deterministic and probabilistic sensitivity analyses. RESULTS: With only the tacrolimus optimisation and the postoperative complication prevention domains included, the incremental cost and QALY compared to standard practice were AU$2,030 (US$1,471) and 0.0003, respectively (incremental cost-effectiveness ratio [ICER]: AU$6.2 million [US$4.5 million] per QALY gained). Including all four domains reduced the incremental cost to AU$1,800 (US$1,300) and increased the QALYs gained to 0.0170 (ICER: AU$106,000 [US$77,000] per QALY gained). Results were sensitive to genomic test cost, incremental cost and QALY after germline cancer and cardiovascular conditions screening, rejection rates, and cascade-testing uptake. The probability of cost-effectiveness was 0.14-0.79 at AU$50,000-150,000 (US$36,234-108,701) per QALY thresholds. CONCLUSION: Considering wider benefits of genomic medicine can materially change its estimated cost-effectiveness. Lower genomic test cost and better quantification of genotype-guided tacrolimus dosing benefits could improve its cost-effectiveness in Australia.
- Keywords
- Cost-utility analysis; Familial testing; Genome sequencing; Genomic screening; Pharmacogenomics; Transplantation
- Department(s)
- Familial Cancer Centre
- Publisher's Version
- https://doi.org/10.1016/j.jval.2026.06.013
- Open Access at Publisher's Site
https://doi.org/10.1016/j.jval.2026.06.013- Terms of Use/Rights Notice
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Creation Date: 2026-08-13 12:12:34
Last Modified: 2026-08-13 12:12:40