Economic Evaluation of Population-Based BRCA1 and BRCA2 Testing in Canada.

Autor:	Sun L; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom., Wei X; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom., Fierheller CT; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom., Dawson L; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada., Oxley S; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom., Kalra A; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom., Sia J; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom., Feldman F; Prevention, Screening, Hereditary Cancer Program and Quality, Safety & Accreditation, BC Cancer Agency, Vancouver, Canada., Peacock S; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.; Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada., Schrader KA; Hereditary Cancer Program, BC Cancer Agency, Vancouver, Canada.; Department of Medical Genetics, University of British Columbia, Vancouver, Canada., Legood R; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom., Kwon JS; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada., Manchanda R; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.; Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom.; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Sep 03; Vol. 7 (9), pp. e2432725. Date of Electronic Publication: 2024 Sep 03.
DOI:	10.1001/jamanetworkopen.2024.32725
Abstrakt:	Importance: Population-based BRCA testing can identify many more BRCA carriers who will be missed by the current practice of BRCA testing based on family history (FH) and clinical criteria. These carriers can benefit from screening and prevention, potentially preventing many more breast and ovarian cancers and deaths than the current practice. Objective: To estimate the incremental lifetime health outcomes, costs, and cost-effectiveness associated with population-based BRCA testing compared with FH-based testing in Canada. Design, Setting, and Participants: For this economic evaluation, a Markov model was developed to compare the lifetime costs and outcomes of BRCA1/BRCA2 testing for all general population women aged 30 years compared with FH-based testing. BRCA carriers are offered risk-reducing salpingo-oophorectomy to reduce their ovarian cancer risk and magnetic resonance imaging (MRI) and mammography screening, medical prevention, and risk-reducing mastectomy to reduce their breast cancer risk. The analyses were conducted from both payer and societal perspectives. This study was conducted from October 1, 2022, to February 20, 2024. Main Outcomes and Measures: Outcomes of interest were ovarian cancer, breast cancer, additional heart disease deaths, and incremental cost-effectiveness ratio ICER per quality-adjusted life-year (QALY). One-way and probabilistic-sensitivity-analyses (PSA) were undertaken to explore the uncertainty. Results: In the simulated cohort of 1 000 000 women aged 30 years in Canada, the base case ICERs of population-based BRCA testing were CAD $32 276 (US $23 402.84) per QALY from the payer perspective or CAD $16 416 (US $11 903.00) per QALY from the societal perspective compared with FH-based testing, well below the established Canadian cost-effectiveness thresholds. Population testing remained cost-effective for ages 40 to 60 years but not at age 70 years. The results were robust for multiple scenarios, 1-way sensitivity, and PSA. More than 99% of simulations from payer and societal perspectives were cost-effective on PSA (5000 simulations) at the CAD $50 000 (US $36 254.25) per QALY willingness-to-pay threshold. Population-based BRCA testing could potentially prevent an additional 2555 breast cancers and 485 ovarian cancers in the Canadian population, corresponding to averting 196 breast cancer deaths and 163 ovarian cancer deaths per 1 000 000 population. Conclusions and Relevance: In this economic evaluation, population-based BRCA testing was cost-effective compared with FH-based testing in Canada from payer and societal perspectives. These findings suggest that changing the genetic testing paradigm to population-based testing could prevent thousands of breast and ovarian cancers.
Databáze:	MEDLINE
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