Key result
Genetic screening for chronic beryllium disease susceptibility in a hypothetical cohort reduced expected prevalence from 1% to 0.08-0.8%, yielding a net value of information of $1,800-$13,000 per worker.
Value-of-information analysis suggests that genetic screening for beryllium susceptibility could yield positive utility and reduce disease prevalence, though ethical and social factors must be considered.
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Genetic screening may reduce beryllium disease prevalence cost-effectively; leaves open ethical implementation for prospective evaluation.
Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.
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Bartell et al. (2000) studied Occupational chronic beryllium disease (CBD). Genetic screening programs using HLA-DP beta 1*0201 vs. Baseline (no screening) was evaluated on Expected postintervention CBD prevalence rates and net value-of-information (VOI). Genetic screening for chronic beryllium disease susceptibility in a hypothetical cohort reduced expected prevalence from 1% to 0.08-0.8%, yielding a net value of information of $1,800-$13,000 per worker.
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