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Economic evaluation of population-based brca1/brca2 mutation testing across multiple countries and health systems

Cancers, ISSN: 2072-6694, Vol: 12, Issue: 7, Page: 1-38
2020
  • 53
    Citations
  • 0
    Usage
  • 96
    Captures
  • 9
    Mentions
  • 69
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    53
    • Citation Indexes
      53
  • Captures
    96
  • Mentions
    9
    • News Mentions
      8
      • 8
    • Blog Mentions
      1
      • Blog
        1
  • Social Media
    69
    • Shares, Likes & Comments
      69
      • Facebook
        69

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Article Description

Clinical criteria/Family history-based BRCA testing misses a large proportion of BRCA carriers who can benefit from screening/prevention. We estimate the cost-effectiveness of population-based BRCA testing in general population women across different countries/health systems. A Markov model comparing the lifetime costs and effects of BRCA1/BRCA2 testing all general population women ≥30 years compared with clinical criteria/FH-based testing. Separate analyses are undertaken for the UK/USA/Netherlands (high-income countries/HIC), China/Brazil (upper–middle income countries/UMIC) and India (low–middle income countries/LMIC) using both health system/payer and societal perspectives. BRCA carriers undergo appropriate screening/prevention interventions to reduce breast cancer (BC) and ovarian cancer (OC) risk. Outcomes include OC, BC, and additional heart disease deaths and incremental cost-effectiveness ratio (ICER)/quality-adjusted life year (QALY). Probabilistic/one-way sensitivity analyses evaluate model uncertainty. For the base case, from a societal perspective, we found that population-based BRCA testing is cost-saving in HIC (UK-ICER = $−5639/QALY; USA-ICER = $−4018/QALY; Netherlands-ICER = $−11,433/QALY), and it appears cost-effective in UMIC (China-ICER = $18,066/QALY; Brazil-ICER = $13,579/QALY), but it is not cost-effective in LMIC (India-ICER = $23,031/QALY). From a payer perspective, population-based BRCA testing is highly cost-effective in HIC (UK-ICER = $21,191/QALY, USA-ICER = $16,552/QALY, Netherlands-ICER = $25,215/QALY), and it is cost-effective in UMIC (China-ICER = $23,485/QALY, Brazil−ICER = $20,995/QALY), but it is not cost-effective in LMIC (India-ICER = $32,217/QALY). BRCA testing costs below $172/test (ICER = $19,685/QALY), which makes it cost-effective (from a societal perspective) for LMIC/India. Population-based BRCA testing can prevent an additional 2319 to 2666 BC and 327 to 449 OC cases per million women than the current clinical strategy. Findings suggest that population-based BRCA testing for countries evaluated is extremely cost-effective across HIC/UMIC health systems, is cost-saving for HIC health systems from a societal perspective, and can prevent tens of thousands more BC/OC cases.

Bibliographic Details

Manchanda, Ranjit; Sun, Li; Patel, Shreeya; Evans, Olivia; Wilschut, Janneke; De Freitas Lopes, Ana Carolina; Gaba, Faiza; Brentnall, Adam; Duffy, Stephen; Cui, Bin; Coelho De Soarez, Patricia; Husain, Zakir; Hopper, John; Sadique, Zia; Mukhopadhyay, Asima; Yang, Li; Berkhof, Johannes; Legood, Rosa

MDPI AG

Medicine; Biochemistry, Genetics and Molecular Biology

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