Incremental cost-effectiveness of algorithm-driven genetic testing versus no testing for Maturity Onset Diabetes of the Young (MODY) in Singapore

Background Offering genetic testing for Maturity Onset Diabetes of the Young (MODY) to all young patients with type 2 diabetes has been shown to be not cost-effective. This study tests whether a novel algorithm-driven genetic testing strategy for MODY is incrementally cost-effective relative to the setting of no testing. Methods A decision tree was constructed to estimate the costs and effectiveness of the algorithm-driven MODY testing strategy and a strategy of no genetic testing over a 30-year time horizon from a payer's perspective. The algorithm uses glutamic acid decarboxylase (GAD) antibody testing (negative antibodies), age of onset of diabetes (< 45 years) and body mass index (< 25 kg/m(2) if diagnosed > 30 years) to stratify the population of patients with diabetes into three subgroups, and testing for MODY only among the subgroup most likely to have the mutation. Singaporespecific costs and prevalence of MODY obtained from local studies and utility values sourced from the literature are used to populate the model. Results The algorithm-driven MODY testing strategy has an incremental cost-effectiveness ratio of US$ 93 663 per quality-adjusted life year relative to the no testing strategy. If the price of genetic testing falls from US$ 1050 to US$ 530 (a 50% decrease), it will become cost-effective. Conclusion Our proposed algorithm-driven testing strategy for MODY is not yet cost-effective based on established benchmarks. However, as genetic testing prices continue to fall, this strategy is likely to become costeffective in the near future.