October 15, 2019
Unselected genetic testing of all women following breast cancer diagnosis appears highly cost-effective compared with the standard practice of testing select women based on clinical criteria or family history, according to a study published online in JAMA Oncology.
“Our analysis suggests that an unselected testing strategy is extremely cost-effective for UK and US health systems and provides a basis for change in current guidelines and policy to implement this strategy,” researchers wrote.
The conclusion stems from a cost-effectiveness microsimulation modeling study that included data for 11,836 women with breast cancer in the United States and in the United Kingdom.
Compared with BRCA1/BRCA2 testing based on clinical criteria or family history, unselected BRCA1/BRCA2/PALB2 testing upon breast cancer diagnosis had an incremental cost-effectiveness ratio of $65,661 (payer perspective) or $61,618 (societal perspective) per quality-adjusted life-year in the United States, and £10,464 (payer perspective) or £7216 (societal perspective) per quality-adjusted life-year in the United Kingdom, according to the study. The amounts are well below established cost-effectiveness thresholds for health systems in both countries, researchers pointed out.
Furthermore, unselected multigene testing could prevent 5478 cases of breast cancer and 4255 cases of ovarian cancer, and 2406 deaths from breast and ovarian cancers, in the United States annually. In the United Kingdom, it could prevent 1142 cases of breast cancer and 959 cases of ovarian cancer, and 633 deaths from such cancers, per year.
“Continuing with the current family history- or clinical criteria–based policy reflects important opportunities missed for breast cancer and ovarian cancer prevention,” researchers wrote.
Sun L, Brentnall A, Patel S, et al. A cost-effectiveness analysis of multigene testing for all patients with breast cancer [published online October 3, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2019.3323