By: Staff Reporter
Health systems in the UK and US could cost-effectively screen all women with breast cancer for risky germline changes in a handful of breast or ovarian cancer genes, according to a new economic modeling analysis, identifying at-risk individuals who could benefit from additional imaging tests and cancer-reducing interventions.
“[T]he costs of testing falling … can provide huge new opportunities for cancer prevention and changes in the way we deliver cancer genetic testing,” corresponding and co-senior author Ranjit Manchanda, a consultant gynecological oncologist and preventive medicine researcher affiliated with the Royal London Hospital and Queen Mary University of London’s Barts Cancer Institute, said in a statement. “This approach can ensure that more women can take preventative action to reduce their cancer risk or undertake regular screening.”
As they reported online today in JAMA Oncology, Manchanda and colleagues from the UK, the US, Australia, and China evaluated the cost-effectiveness and potential health effects of multigene testing in unselected breast cancer patients or in individuals who met current family history- or clinical feature-based criteria.
Based on data for 11,836 breast cancer patients in the UK, US, and Australia who were tested for high-risk variants in the BRCA1, BRCA2, and PALB2 genes — together with information on related screening strategies and interventions for those with cancer-related variants in these genes — the investigators concluded that the unselected approach was cost-effective for both payors and society in some 98 to 99 percent of UK health system simulations and between 64 and 68 percent of simulations done in the context of the US health system.
“Our analysis suggests that an unselected testing strategy is extremely cost-effective for UK and US health systems,” the authors concluded, “and provides a basis for change in current guidelines and policy to implement this strategy.”
Using incremental cost-effectiveness ratio analyses, the team estimated that unselected testing for women with breast cancer would cost the UK health payor £10,464 ($12,966) per quality-adjusted life year (QALY) gained by those tested, while the cost for US payors would be $65,661 for each additional QALY. The societal cost estimates came in at £7,216 ($8,941) per QALY in the UK and $61,618 per QALY in the US.
“Our analysis shows that testing all women with breast cancer for breast and ovarian cancer gene mutations is a more cost-effective strategy which can prevent these cancers in high-risk women and save lives,” co-senior author Rosa Legood, a health services research and policy researcher at the London School of Hygiene and Tropical Medicine, said in a statement. “This approach has important implications given the effective options that are available for breast and ovarian cancer risk management and prevention for women at increased risk.”
The investigators projected that BRCA1, BRCA2, and PALB2 gene testing in all breast cancer patients over one year could translate into 2,101 fewer breast or ovarian cancer cases, for example, and 633 related deaths, in the UK. In the US, the same analysis suggested that a year of unselected testing could prevent more than 9,700 cancer cases and 2,406 breast or ovarian cancer deaths.
The analyses took into account the potential interventions, enhanced screening, and cascade testing options available for those with risky germline variants and their family members, the team explained, including mammography, magnetic resonance imaging, chemoprevention treatments, or double mastectomy/oophorectomy surgeries.
Such results suggested that “unselected multigene testing for [breast cancer] susceptibility genes BRCA1/BRCA2/PALB2 can substantially reduce future [breast cancer] and [ovarian cancer] cases and related deaths compared with the current clinical strategy,” the authors reported.
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