Economic Evaluation of Population-Based BRCA1 and BRCA2 Testing in Canada
Li Sun1,2, Xia Wei1,2, Caitlin T Fierheller2
1Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
JAMA Network Open
|September 12, 2024
Summary
Population-based BRCA testing is more cost-effective than family history-based testing in Canada. This approach can identify more BRCA carriers, potentially preventing thousands of breast and ovarian cancers and deaths.
Area of Science:
- Genetics and Genomics
- Public Health
- Health Economics
Background:
- Current BRCA testing relies on family history (FH), missing many carriers.
- Population-based BRCA testing offers broader identification of at-risk individuals.
- Early identification enables timely screening and prevention strategies for hereditary cancers.
Purpose of the Study:
- To evaluate the cost-effectiveness of population-based BRCA testing versus FH-based testing in Canada.
- To estimate the incremental lifetime health outcomes and costs associated with each testing strategy.
- To inform policy decisions regarding genetic screening for BRCA mutations.
Main Methods:
- A Markov model was developed for economic evaluation.
- Compared lifetime costs and outcomes for population-based vs. FH-based BRCA testing in Canadian women.
- Included risk-reducing interventions and analyzed from payer and societal perspectives.
Main Results:
- Population-based BRCA testing yielded incremental cost-effectiveness ratios (ICERs) below Canadian thresholds (CAD $32,276 payer; CAD $16,416 societal).
- Cost-effectiveness was observed for ages 30-60, but not 70.
- Over 99% of simulations were cost-effective, with potential to prevent 2555 breast and 485 ovarian cancers per million women.
Conclusions:
- Population-based BRCA testing is a cost-effective strategy in Canada compared to FH-based testing.
- This approach can significantly increase the detection of BRCA carriers.
- Shifting to population-based testing could prevent a substantial number of breast and ovarian cancers.
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