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

The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision–analyti...

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Autores principales: Mohammadi, Tima, Sadatsafavi, Mohsen, Carlsten, Chris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983226/
https://www.ncbi.nlm.nih.gov/pubmed/33778052
http://dx.doi.org/10.1183/23120541.00790-2020
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author Mohammadi, Tima
Sadatsafavi, Mohsen
Carlsten, Chris
author_facet Mohammadi, Tima
Sadatsafavi, Mohsen
Carlsten, Chris
author_sort Mohammadi, Tima
collection PubMed
description The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision–analytic model was used to conduct a cost-utility analysis of prevention interventions in case of acute exposure to air pollution in mild asthma. Three different strategies, as follows, were compared: no preventive intervention; precision health strategy based on information from genotype testing, followed with treating high-risk patients; and prescribing additional medication to all mild asthmatics as a preventive intervention. The costs and quality-adjusted life years (QALYs) in the base case and alternative scenarios were obtained through probabilistic analysis. The results showed that the precision prevention intervention (anticipatory intervention for asthmatics, guided by relevant genetic abnormality, in the face of acute air pollution) is a cost-effective strategy compared with no such intervention, with an incremental cost-effectiveness ratio of CAD 49 555 per QALY. Furthermore, this strategy is a dominant strategy compared with an intervention that prescribes medication indiscriminately to all asthmatics. The incorporation of genomic testing to stratify risk of asthmatics to pollution-driven exacerbations, and then tailoring a preventive intervention accordingly, may be cost effective relative to untailored methods. These results lend plausibility to the use of precision medicine for limiting asthma exacerbation in the context of air pollution and, potentially, other exposures.
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spelling pubmed-79832262021-03-26 The economics of precision health: preventing air pollution-induced exacerbation in asthma Mohammadi, Tima Sadatsafavi, Mohsen Carlsten, Chris ERJ Open Res Original Articles The demonstrable value of precision medicine, in the context of common environmental exposures, has scarcely been explored. This study evaluated the cost effectiveness of a preventive personalised intervention to reduce the adverse effect of air pollution in the context of asthma. A decision–analytic model was used to conduct a cost-utility analysis of prevention interventions in case of acute exposure to air pollution in mild asthma. Three different strategies, as follows, were compared: no preventive intervention; precision health strategy based on information from genotype testing, followed with treating high-risk patients; and prescribing additional medication to all mild asthmatics as a preventive intervention. The costs and quality-adjusted life years (QALYs) in the base case and alternative scenarios were obtained through probabilistic analysis. The results showed that the precision prevention intervention (anticipatory intervention for asthmatics, guided by relevant genetic abnormality, in the face of acute air pollution) is a cost-effective strategy compared with no such intervention, with an incremental cost-effectiveness ratio of CAD 49 555 per QALY. Furthermore, this strategy is a dominant strategy compared with an intervention that prescribes medication indiscriminately to all asthmatics. The incorporation of genomic testing to stratify risk of asthmatics to pollution-driven exacerbations, and then tailoring a preventive intervention accordingly, may be cost effective relative to untailored methods. These results lend plausibility to the use of precision medicine for limiting asthma exacerbation in the context of air pollution and, potentially, other exposures. European Respiratory Society 2021-03-22 /pmc/articles/PMC7983226/ /pubmed/33778052 http://dx.doi.org/10.1183/23120541.00790-2020 Text en Copyright ©The authors 2021 http://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Original Articles
Mohammadi, Tima
Sadatsafavi, Mohsen
Carlsten, Chris
The economics of precision health: preventing air pollution-induced exacerbation in asthma
title The economics of precision health: preventing air pollution-induced exacerbation in asthma
title_full The economics of precision health: preventing air pollution-induced exacerbation in asthma
title_fullStr The economics of precision health: preventing air pollution-induced exacerbation in asthma
title_full_unstemmed The economics of precision health: preventing air pollution-induced exacerbation in asthma
title_short The economics of precision health: preventing air pollution-induced exacerbation in asthma
title_sort economics of precision health: preventing air pollution-induced exacerbation in asthma
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983226/
https://www.ncbi.nlm.nih.gov/pubmed/33778052
http://dx.doi.org/10.1183/23120541.00790-2020
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