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

• Main Authors: Ranjit Manchanda, Li Sun, Shreeya Patel, Olivia Evans, Janneke Wilschut, Ana Carolina De Freitas Lopes, Faiza Gaba, Adam Brentnall, Stephen Duffy, Bin Cui, Patricia Coelho De Soarez, Zakir Husain, John Hopper, Zia Sadique, Asima Mukhopadhyay, Li Yang, Johannes Berkhof, Rosa Legood
• Format: Article
• Language: English
• Published: MDPI AG 2020-07-01
• Series: Cancers
• Subjects: BRCA; population testing; cost-effectiveness; ovarian cancer; breast cancer; cancer prevention
• Online Access: https://www.mdpi.com/2072-6694/12/7/1929

Clinical criteria/Family history-based <i>BRCA</i> testing misses a large proportion of <i>BRCA</i> carriers who can benefit from screening/prevention. We estimate the cost-effectiveness of population-based <i>BRCA</i> testing in general population women across different countries/health systems. A Markov model comparing the lifetime costs and effects of <i>BRCA1/BRCA2</i> 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. <i>BRCA</i> 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 <i>BRCA</i> 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 <i>BRCA</i> 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). <i>BRCA</i> testing costs below $172/test (ICER = $19,685/QALY), which makes it cost-effective (from a societal perspective) for LMIC/India. Population-based <i>BRCA</i> 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 <i>BRCA</i> 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.