Table 3.
Costs
| BRCA testing, RRS, and surveillance | Cost (£) | Reference | ||
|---|---|---|---|---|
| BRCA testing | ||||
| Index case (full genes) | 306 | Royal Marsden [61] | ||
| Family members (specific mutation only) | 108 | Royal Marsden [61] | ||
| Genetic counseling, per 2-h session | 126 | NICE CG164 [62]: On the basis of rate per hour of patient contact for band 7 counselor in primary medical care | ||
| RRS | ||||
| Mastectomy including reconstructive surgery | 9,219 | NHS reference costs 2014–2015 [63]: Weighted average of HRG codes JA27Z and JA28Z | ||
| BSO | 2,976 | NHS reference costs 2014–2015 MA08A–MA08B [63] | ||
| HRT, per year | 120.95 | BNF 69 2015 [64] and HSCIC prescription cost analysis 2014 [65]: Weighted average of Kliovance, Evorel Conti, and Evorel Sequi | ||
| Surveillance | ||||
| MRI, per year | 191 | NHS reference costs 2014–2015 [63]: HRG code RA05Z | ||
| Mammography, per year | 55 | NICE CG144 costing report for venous thromboembolic diseases [66]; uplifted using PSSRU unit costs of health and social care 2014 [67] | ||
| Treatment | Unit cost (£) | Dose/units | Total cost (£) | Reference |
| Breast cancer | ||||
| Breast surgery | 3,186 | 1 | 3,816 | NHS reference costs 2014–2015 [63]: Weighted average of HRG codes JA28A–C, JA39Z–JA41Z |
| Adjuvant radiotherapy | 132 | 15 | 1,978 | NHS reference costs 2014–2015 [63]: HRG code SC23Z |
| Chemotherapy delivery: first attendance | 389 | 1 | 389 | NHS reference costs 2014–2015 [63]: HRG code SB14Z |
| Chemotherapy delivery: subsequent attendance | 326 | 5 | 1,632 | NHS reference costs 2014–2015 [63]: HRG code SB15Z |
| Chemotherapy drugs (fluorouracil, epirubicin, cyclophosphamide) | 205 | 6 | 1,230 | BNF 69 2015 [64] |
| Neulasta* | 686 | 6 | 4,118 | BNF 69 2015 [64] |
| Dexamethasone† | 0.78 | 16 mg OD for 2 days | 12 | BNF 69 2015 [64] |
| Anastrozole‡ | 0.07 | 1 mg OD for 5 y | Variable§ | BNF 69 2015 [64] |
| Total with surgery | 13,189 | – | ||
| Total without surgery | 9,373 | – | ||
| Ovarian cancer | ||||
| Debulking surgery | 5,613 | 1 | 5,613 | NHS reference costs 2014–2015 MA26A–MA26C [63] |
| Chemotherapy delivery: first attendance | 389 | 1 | 389 | NHS reference costs 2014–2015 [63]: HRG code SB14Z |
| Chemotherapy delivery: subsequent attendance | 326 | 5 | 1,632 | NHS reference costs 2014–2015 [63]: HRG code SB15Z |
| Chemotherapy drugs (33% carboplatin, 67% carboplatin + paclitaxel) | 568 | 6 | 3,408 | BNF 69 2015 [64] |
| Neulasta* | 668 | 6 | 4,118 | BNF 69 2015 [64] |
| Dexamethasone† | 0.78 | 16 mg OD for 2 days | 12 | BNF 69 2015 [64] |
| Total with surgery | 15,185 | – | ||
| Total without surgery | 9,572 | – | ||
| Condition | Cost (£) | Reference | ||
| Palliative care | ||||
| Breast cancer | 3,702 | UK study of treatment patterns and resource costs for specific advanced cancer patients [68]; uplifted to 2013–2014 costs from PSSRU [67] | ||
| Ovarian cancer | 7,143 | |||
| All-cause mortality | 103 | NHS reference costs 2014–2015 [63]: HRG code SD03A | ||
BNF, British National Formulary; BSO, bilateral salpingo-oophorectomy; HRG, Healthcare Resource Group; HRT, hormone replacement therapy; HSCIC, Health and Social Care Information Centre; MRI, magnetic resonance imaging; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; OD, one daily; PSSRU, Personal Social Services Research Unit; RRS, risk-reducing surgery.
Used to treat neutropenia to reduce the risk of infection.
Used to treat inflammation, relieve sickness, and boost appetite.
Used to inhibit the synthesis of estrogen as adjuvant treatment in estrogen-receptor– positive breast cancer.
The total cost of anastrozole varies between patients because some patients may die within the 5 years specified to receive this medication.