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The economics of precision health: preventing air pollution-induced exacerbation in asthma

Tima Mohammadi, Mohsen Sadatsafavi, Chris Carlsten
ERJ Open Research 2021 7: 00790-2020; DOI: 10.1183/23120541.00790-2020
Tima Mohammadi
1Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
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Mohsen Sadatsafavi
2Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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  • ORCID record for Mohsen Sadatsafavi
Chris Carlsten
3Air Pollution Exposure Laboratory, Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
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  • ORCID record for Chris Carlsten
  • For correspondence: carlsten@mail.ubc.ca
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  • FIGURE 1
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    FIGURE 1

    Schematic diagram of the model. GA: genetic abnormality.

  • FIGURE 2
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    FIGURE 2

    Cost-effectiveness acceptability curve comparing no intervention with targeted intervention.

  • FIGURE 3
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    FIGURE 3

    Scenario analysis (tornado diagram). ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life-year.

Tables

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  • TABLE 1

    Model inputs

    ParameterMeanDistributionReference
    Probabilities
     Prevalence of asthma323 500Fixed[19]
     Percentage of mild asthma67.1%Fixed[4]
     Prevalence of genetic abnormality (GSTT1 null, GSTM1 null or GSTP1 Ile105)25%Fixed[20, 21]
     Risk of additional exacerbation in asthmatics with genetic abnormality, without preventive intervention55%Beta (42.7, 34.9)[22, 23]
     Risk of additional exacerbation in asthmatics with genetic abnormality, with preventive intervention5%Beta (91.2,1732.5)[22, 23]
     Risk of additional exacerbation in asthmatics without genetic abnormality (with or without preventive intervention)0Fixed
    Unit costs
     Advair 500/50 twice per day (per month)$74.7Fixed[19]
     Exacerbation without hospitalisation$126Gamma (96.04,0.76)[24]
    (Converted to 2018 CAD)
     Exacerbation requiring emergency room visits$575Gamma (96,0.17)[24]
    (Converted to 2018 CAD)
     Exacerbation requiring hospitalisations$6440Gamma (96,0.014)[24]
    (Converted to 2018 CAD)
     Genetic testing109.43Fixed[25]
    (Converted to 2018 CAD)
    Utilities
     Exacerbation without hospitalisation0.57Beta (0.51, 0.38)[26]
     Exacerbation requiring emergency room visits0.45Beta (0.36, 0.45)[26]
     Exacerbation requiring hospitalisations0.33Beta (0.15, 0.30)[26]
    • CAD: Canadian dollars.

  • TABLE 2

    The expected value of costs, QALY and incremental cost per QALY (base case) per one patient with mild asthma

    StrategyCosts ($)QALY lossSequential incremental costsSequential incremental QALY lossSequential incremental cost per QALY Gained
    No intervention42.130.0024
    Preventive intervention only for asthmatics with genetic abnormality150.580.00021108.45−0.00219$49 555
    Preventive intervention for all asthmatics153.20.000212.610Dominated

    QALY: quality-adjusted life-year. All the numbers are per asthmatic.

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material 00790-2020.SUPPLEMENT

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    The economics of precision health: preventing air pollution-induced exacerbation in asthma
    Tima Mohammadi, Mohsen Sadatsafavi, Chris Carlsten
    ERJ Open Research Jan 2021, 7 (1) 00790-2020; DOI: 10.1183/23120541.00790-2020

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    The economics of precision health: preventing air pollution-induced exacerbation in asthma
    Tima Mohammadi, Mohsen Sadatsafavi, Chris Carlsten
    ERJ Open Research Jan 2021, 7 (1) 00790-2020; DOI: 10.1183/23120541.00790-2020
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    • Asthma and allergy
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