Cost Efficacy of α-Galactosidase A Enzyme Screening for Fabry Disease

Darrell B. Newman, William R. Miranda, Dietrich Matern, Dawn S. Peck, Jeffrey B. Geske, Joseph Maleszewski, Steve R. Ommen, Michael John Ackerman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The prevalence of Fabry disease (FD) in adult patients with suspected hypertrophic cardiomyopathy (HCM) has been reported between 0.3% and 4%. Fabry disease–specific therapy necessitates early diagnosis; however, the optimal screening strategy and cost efficacy of routine α-galactosidase A (α-gal A) vs comprehensive galactosidase alpha gene (GLA) testing remain poorly understood. We identified 1192 patients who underwent routine α-gal A screening between January 1, 2011, and December 31, 2017, for suspected HCM. Cost efficacy was explored using prevalence and cost estimates. Ten patients had reduced α-gal A enzyme activity, and 5 (3 women) were ultimately diagnosed with FD (prevalence estimate, 0.42%). An alternative cardiac diagnosis was made in 3 patients with mildly reduced enzyme activity. Two women with reduced borderline enzyme levels did not undergo confirmatory testing, but FD was not suspected. The number needed to screen to diagnose 1 patient with FD in a similar cohort is estimated at 238 (5 new cases per 1192 at-risk individuals) at a cost of approximately US $24,000 per diagnosis. We identified a 0.42% prevalence of FD using routine α-gal A screening in adult patients referred to a dedicated HCM center in the United States. Compared with more comprehensive genetic testing strategies, we identified a similar prevalence of FD at a lower cost per diagnosis.

Original languageEnglish (US)
Pages (from-to)84-88
Number of pages5
JournalMayo Clinic Proceedings
Volume94
Issue number1
DOIs
StatePublished - Jan 1 2019

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Galactosidases
Fabry Disease
Costs and Cost Analysis
Hypertrophic Cardiomyopathy
Enzymes
Genetic Testing
Early Diagnosis
Genes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cost Efficacy of α-Galactosidase A Enzyme Screening for Fabry Disease. / Newman, Darrell B.; Miranda, William R.; Matern, Dietrich; Peck, Dawn S.; Geske, Jeffrey B.; Maleszewski, Joseph; Ommen, Steve R.; Ackerman, Michael John.

In: Mayo Clinic Proceedings, Vol. 94, No. 1, 01.01.2019, p. 84-88.

Research output: Contribution to journalArticle

Newman, Darrell B. ; Miranda, William R. ; Matern, Dietrich ; Peck, Dawn S. ; Geske, Jeffrey B. ; Maleszewski, Joseph ; Ommen, Steve R. ; Ackerman, Michael John. / Cost Efficacy of α-Galactosidase A Enzyme Screening for Fabry Disease. In: Mayo Clinic Proceedings. 2019 ; Vol. 94, No. 1. pp. 84-88.
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abstract = "The prevalence of Fabry disease (FD) in adult patients with suspected hypertrophic cardiomyopathy (HCM) has been reported between 0.3{\%} and 4{\%}. Fabry disease–specific therapy necessitates early diagnosis; however, the optimal screening strategy and cost efficacy of routine α-galactosidase A (α-gal A) vs comprehensive galactosidase alpha gene (GLA) testing remain poorly understood. We identified 1192 patients who underwent routine α-gal A screening between January 1, 2011, and December 31, 2017, for suspected HCM. Cost efficacy was explored using prevalence and cost estimates. Ten patients had reduced α-gal A enzyme activity, and 5 (3 women) were ultimately diagnosed with FD (prevalence estimate, 0.42{\%}). An alternative cardiac diagnosis was made in 3 patients with mildly reduced enzyme activity. Two women with reduced borderline enzyme levels did not undergo confirmatory testing, but FD was not suspected. The number needed to screen to diagnose 1 patient with FD in a similar cohort is estimated at 238 (5 new cases per 1192 at-risk individuals) at a cost of approximately US $24,000 per diagnosis. We identified a 0.42{\%} prevalence of FD using routine α-gal A screening in adult patients referred to a dedicated HCM center in the United States. Compared with more comprehensive genetic testing strategies, we identified a similar prevalence of FD at a lower cost per diagnosis.",
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