Table 4.
Costs of TC Versus UC Genetic Counseling and Testing Under Various Assumptions
| Scenario* and Changed Variable for Sensitivity Analysis | Cost ($) |
||
|---|---|---|---|
| UC | TC | Incremental (compared with UC) | |
| Base case | 3,773.90 | 3,659.50 | −114.40 |
| Scenario 1 | |||
| Proband only | 3,775.20 | 3,665.10 | −110.20 |
| Relative only | 3,755.50 | 3,636.10 | −118.80 |
| Scenario 2 | |||
| Urban area (round-trip, 1 hour)† | 3,763.60 | 3,654.40 | −109.20 |
| Rural area (round-trip, 2 hours)† | 3,826.40 | 3,685.80 | −140.60 |
| Rural area (round-trip, 4 hours)† | 3,952.30 | 3,748.70 | −203.60 |
| Scenario 3 | |||
| Preparation time of genetic counselors in nonresearch setting | 3,718.70 | 3,604.30 | −114.40 |
| Scenario 4 | |||
| Patients use cell phone for counseling in the telephone arm‡ | 3,773.90 | 3,667.30 | −106.60 |
| Scenario 5 | |||
| Both UC and TC arms use buccal swab for DNA collection | 3,783.80 | 3,630.90 | −153.00 |
| Scenario 6 | |||
| Equivalent overhead for TC and UC | 3,773.90 | 3,714.00 | −59.90 |
| Scenario 7 | |||
| Actual rates of genetic testing and disclosure§ | 3,450.80 | 3,099.80 | −351.00 |
| Scenario 8 | |||
| Buccal swab + rural area (round-trip, 2 hours) | 3,826.40 | 3,630.90 | −195.60 |
| Buccal swab + rural area (round-trip, 4 hours) | 3,952.30 | 3,630.90 | −321.40 |
Abbreviations: TC, telephone genetic counseling; UC, usual care (standard in-person genetic counseling).
To isolate the costs and effects of counseling, in the base case and scenarios 1 through 6, we assume that all participants have genetic testing (and post-test disclosure) in both arms. In scenario 7, this assumption is evaluated.
Assuming rural travel time of 75 or 150 miles each way v 30 minutes in urban locations.
The basic rate for Verizon: any time minutes = 450 minutes and monthly access rate = $39.99. The initial and post-testing counseling time for TC is 87.7 minutes (64 + 23.7 minutes). Thus, the cell phone cost is 87.7/450 × $39.99 = $7.80 per patient.
The actual rates of genetic testing and disclosure for UC and TC arms are 90.7% and 83.9%, respectively, so only these proportions of patients accrue testing costs (and post-test disclosure).