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Open AccessArticle

Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems

1
Wolfson Institute for Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
2
Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
3
MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
4
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
5
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
6
Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, 01246903 Sao Paulo, Brazil
7
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
8
School of Public Health, Peking University, Beijing 100191, China
9
Department of Humanities & Social Sciences, Indian Institute of Technology, Kharagpur, West Bengal 721302, India
10
Department of Economics, Presidency University, Kolkata 700073, India
11
Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria 3010, Australia
12
Tata Medical Centre, Kolkata, West Bengal 700160, India
13
Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(7), 1929; https://doi.org/10.3390/cancers12071929
Received: 7 June 2020 / Revised: 7 July 2020 / Accepted: 13 July 2020 / Published: 17 July 2020
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. View Full-Text
Keywords: BRCA; population testing; cost-effectiveness; ovarian cancer; breast cancer; cancer prevention BRCA; population testing; cost-effectiveness; ovarian cancer; breast cancer; cancer prevention
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MDPI and ACS Style

Manchanda, R.; Sun, L.; Patel, S.; Evans, O.; Wilschut, J.; De Freitas Lopes, A.C.; Gaba, F.; Brentnall, A.; Duffy, S.; Cui, B.; Coelho De Soarez, P.; Husain, Z.; Hopper, J.; Sadique, Z.; Mukhopadhyay, A.; Yang, L.; Berkhof, J.; Legood, R. Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems. Cancers 2020, 12, 1929. https://doi.org/10.3390/cancers12071929

AMA Style

Manchanda R, Sun L, Patel S, Evans O, Wilschut J, De Freitas Lopes AC, Gaba F, Brentnall A, Duffy S, Cui B, Coelho De Soarez P, Husain Z, Hopper J, Sadique Z, Mukhopadhyay A, Yang L, Berkhof J, Legood R. Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems. Cancers. 2020; 12(7):1929. https://doi.org/10.3390/cancers12071929

Chicago/Turabian Style

Manchanda, Ranjit; Sun, Li; Patel, Shreeya; Evans, Olivia; Wilschut, Janneke; De Freitas Lopes, Ana C.; 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. 2020. "Economic Evaluation of Population-Based BRCA1/BRCA2 Mutation Testing across Multiple Countries and Health Systems" Cancers 12, no. 7: 1929. https://doi.org/10.3390/cancers12071929

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