BACKGROUND: The National Comprehensive Cancer Network recommends that women who carry gene variants that confer substantial risk for breast cancer consider risk-reduction strategies, that is, enhanced surveillance (breast magnetic resonance imaging and mammography) or prophylactic surgery. Pathogenic variants can be detected in women with a family history of breast or ovarian cancer syndromes by multigene panel testing. OBJECTIVES: To investigate whether using a seven-gene test to identify women who should consider risk-reduction strategies could cost-effectively increase life expectancy. METHODS: We estimated effectiveness and lifetime costs from a payer perspective for two strategies in two hypothetical cohorts of women (40-year-old and 50-year-old cohorts) who meet the National Comprehensive Cancer Network-defined family history criteria for multigene testing. The two strategies were the usual test strategy for variants in BRCA1 and BRCA2 and the seven-gene test strategy for variants in BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, and PALB2. Women found to have a pathogenic variant were assumed to undergo either prophylactic surgery or enhanced surveillance. RESULTS: The incremental cost-effectiveness ratio for the seven-gene test strategy compared with the BRCA1/2 test strategy was $42,067 per life-year gained or $69,920 per quality-adjusted life-year gained for the 50-year-old cohort and $23,734 per life-year gained or $48,328 per quality-adjusted life-year gained for the 40-year-old cohort. In probabilistic sensitivity analysis, the seven-gene test strategy cost less than $100,000 per life-year gained in 95.7% of the trials for the 50-year-old cohort. CONCLUSIONS: Testing seven breast cancer-associated genes, followed by risk-reduction management, could cost-effectively improve life expectancy for women at risk of hereditary breast cancer.
BACKGROUND: The National Comprehensive Cancer Network recommends that women who carry gene variants that confer substantial risk for breast cancer consider risk-reduction strategies, that is, enhanced surveillance (breast magnetic resonance imaging and mammography) or prophylactic surgery. Pathogenic variants can be detected in women with a family history of breast or ovarian cancer syndromes by multigene panel testing. OBJECTIVES: To investigate whether using a seven-gene test to identify women who should consider risk-reduction strategies could cost-effectively increase life expectancy. METHODS: We estimated effectiveness and lifetime costs from a payer perspective for two strategies in two hypothetical cohorts of women (40-year-old and 50-year-old cohorts) who meet the National Comprehensive Cancer Network-defined family history criteria for multigene testing. The two strategies were the usual test strategy for variants in BRCA1 and BRCA2 and the seven-gene test strategy for variants in BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, and PALB2. Women found to have a pathogenic variant were assumed to undergo either prophylactic surgery or enhanced surveillance. RESULTS: The incremental cost-effectiveness ratio for the seven-gene test strategy compared with the BRCA1/2 test strategy was $42,067 per life-year gained or $69,920 per quality-adjusted life-year gained for the 50-year-old cohort and $23,734 per life-year gained or $48,328 per quality-adjusted life-year gained for the 40-year-old cohort. In probabilistic sensitivity analysis, the seven-gene test strategy cost less than $100,000 per life-year gained in 95.7% of the trials for the 50-year-old cohort. CONCLUSIONS: Testing seven breast cancer-associated genes, followed by risk-reduction management, could cost-effectively improve life expectancy for women at risk of hereditary breast cancer.
Authors: Karl Johnson; Katherine W Saylor; Isabella Guynn; Karen Hicklin; Jonathan S Berg; Kristen Hassmiller Lich Journal: Genet Med Date: 2021-12-07 Impact factor: 8.822
Authors: Kathryn A Phillips; Patricia A Deverka; Deborah A Marshall; Sarah Wordsworth; Dean A Regier; Kurt D Christensen; James Buchanan Journal: Value Health Date: 2018-08-08 Impact factor: 5.725
Authors: Kimberly A Kaphingst; Wendy Kohlmann; Rachelle Lorenz Chambers; Melody S Goodman; Richard Bradshaw; Priscilla A Chan; Daniel Chavez-Yenter; Sarah V Colonna; Whitney F Espinel; Jessica N Everett; Amanda Gammon; Eric R Goldberg; Javier Gonzalez; Kelsi J Hagerty; Rachel Hess; Kelsey Kehoe; Cecilia Kessler; Kadyn E Kimball; Shane Loomis; Tiffany R Martinez; Rachel Monahan; Joshua D Schiffman; Dani Temares; Katie Tobik; David W Wetter; Devin M Mann; Kensaku Kawamoto; Guilherme Del Fiol; Saundra S Buys; Ophira Ginsburg Journal: BMC Health Serv Res Date: 2021-06-02 Impact factor: 2.655
Authors: Sun Hee Rosenthal; Weimin Sun; Ke Zhang; Yan Liu; Quoclinh Nguyen; Anna Gerasimova; Camille Nery; Linda Cheng; Carolyn Castonguay; Elaine Hiller; James Li; Christopher Elzinga; David Wolfson; Alla Smolgovsky; Rebecca Chen; Arlene Buller-Burckle; Joseph Catanese; Andrew Grupe; Felicitas Lacbawan; Renius Owen Journal: Biomed Res Int Date: 2020-01-22 Impact factor: 3.411
Authors: Gregory F Guzauskas; Shawn Garbett; Zilu Zhou; Scott J Spencer; Hadley S Smith; Jing Hao; Dina Hassen; Susan R Snyder; John A Graves; Josh F Peterson; Marc S Williams; David L Veenstra Journal: JAMA Netw Open Date: 2020-10-01