Healthcare Utilization and Costs after Receiving a Positive <i>BRCA1/2</i> Result from a Genomic Screening Program

• Main Authors: Jing Hao, Dina Hassen, Kandamurugu Manickam, Michael F. Murray, Dustin N. Hartzel, Yirui Hu, Kunpeng Liu, Alanna Kulchak Rahm, Marc S. Williams, Amanda Lazzeri, Adam Buchanan, Amy Sturm, Susan R. Snyder
• Format: Article
• Language: English
• Published: MDPI AG 2020-02-01
• Series: Journal of Personalized Medicine
• Subjects: genomic screening; <i>brca1/2</i>; healthcare utilization; healthcare costs; uptake of risk management
• Online Access: https://www.mdpi.com/2075-4426/10/1/7

Population genomic screening has been demonstrated to detect at-risk individuals who would not be clinically identified otherwise. However, there are concerns about the increased utilization of unnecessary services and the associated increase in costs. The objectives of this study are twofold: (1) determine whether there is a difference in healthcare utilization and costs following disclosure of a pathogenic/likely pathogenic (P/LP) <i>BRCA1/2</i> variant via a genomic screening program, and (2) measure the post-disclosure uptake of National Comprehensive Cancer Network (NCCN) guideline-recommended risk management. We retrospectively reviewed electronic health record (EHR) and billing data from a female population of <i>BRCA1/2</i> P/LP variant carriers without a personal history of breast or ovarian cancer enrolled in Geisinger&#8217;s MyCode genomic screening program with at least a one-year post-disclosure observation period. We identified 59 women for the study cohort out of 50,726 MyCode participants. We found no statistically significant differences in inpatient and outpatient utilization and average total costs between one-year pre- and one-year post-disclosure periods ($18,821 vs. $19,359, <i>p</i> = 0.76). During the first year post-disclosure, 49.2% of women had a genetic counseling visit, 45.8% had a mammography and 32.2% had an MRI. The uptake of mastectomy and oophorectomy was 3.5% and 11.8%, respectively, and 5% of patients received chemoprevention.