Cost-effectiveness of Population Screening for BRCA Mutations in Ashkenazi Jewish Women Compared With Family History–Based Testing
Open Access
- 28 November 2014
- journal article
- research article
- Published by Oxford University Press (OUP) in JNCI Journal of the National Cancer Institute
- Vol. 107 (1), 380
- https://doi.org/10.1093/jnci/dju380
Abstract
Population-based testing for BRCA1/2 mutations detects the high proportion of carriers not identified by cancer family history (FH)–based testing. We compared the cost-effectiveness of population-based BRCA testing with the standard FH-based approach in Ashkenazi Jewish (AJ) women. A decision-analytic model was developed to compare lifetime costs and effects amongst AJ women in the UK of BRCA founder-mutation testing amongst: 1) all women in the population age 30 years or older and 2) just those with a strong FH (≥10% mutation risk). The model assumes that BRCA carriers are offered risk-reducing salpingo-oophorectomy and annual MRI/mammography screening or risk-reducing mastectomy. Model probabilities utilize the Genetic Cancer Prediction through Population Screening trial/published literature to estimate total costs, effects in terms of quality-adjusted life-years (QALYs), cancer incidence, incremental cost-effectiveness ratio (ICER), and population impact. Costs are reported at 2010 prices. Costs/outcomes were discounted at 3.5%. We used deterministic/probabilistic sensitivity analysis (PSA) to evaluate model uncertainty. Compared with FH-based testing, population-screening saved 0.090 more life-years and 0.101 more QALYs resulting in 33 days’ gain in life expectancy. Population screening was found to be cost saving with a baseline-discounted ICER of -£2079/QALY. Population-based screening lowered ovarian and breast cancer incidence by 0.34% and 0.62%. Assuming 71% testing uptake, this leads to 276 fewer ovarian and 508 fewer breast cancer cases. Overall, reduction in treatment costs led to a discounted cost savings of £3.7 million. Deterministic sensitivity analysis and 94% of simulations on PSA (threshold £20000) indicated that population screening is cost-effective, compared with current NHS policy. Population-based screening for BRCA mutations is highly cost-effective compared with an FH-based approach in AJ women age 30 years and older.Keywords
This publication has 82 references indexed in Scilit:
- Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant dataThe Lancet, 2013
- Variation in advanced stage at diagnosis of lung and female breast cancer in an English region 2006–2009British Journal of Cancer, 2012
- Less correspondence between expectations before and cosmetic results after risk-reducing mastectomy in women who are mutation carriers: A prospective studyEuropean Journal of Surgical Oncology, 2012
- Relative contributions of BRCA1 and BRCA2 mutations to “triple-negative” breast cancer in Ashkenazi WomenBreast Cancer Research and Treatment, 2011
- What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?British Journal of Cancer, 2009
- Determination of quality of life-related utilities for health states relevant to ovarian cancer diagnosis and treatmentGynecologic Oncology, 2009
- Next-generation DNA sequencingNature Biotechnology, 2008
- Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancerBritish Journal of Cancer, 2006
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Ashkenazi Jewish population frequencies for common mutations in BRCA1 and BRCA2Nature Genetics, 1996