Table 3.
A summary of major findings of the cited studies for economic evaluations.
| Study | Country | Year | Population | Screening approach | Familiar History (FH) approach | Total costs | Results |
|---|---|---|---|---|---|---|---|
| Manchanda R et al. [13] | UK, USA, Netherlands (high-income countries/HIC), China, Brazil (upper–middle income countries/UMIC) and India (low–middle income countries/LMIC) | 2020 | All general population of women ≥30 years compared with clinical-criteria/FH-based testing | societal perspective: $18.568 (UK)/$21,951 (USA)/$24,642 (NL)/$7687 (China)/$6314 (Brazil)/$30,968 (India) payer perspective: $2543 (UK)/$7250 (USA)/$2748 (NL)/$820 (China)/$834 (Brazil)/$634 (India) | societal perspective: $18,623 (UK)/$21,982 (USA)/$24,750 (NL)/$7568 (China)/$6153 (Brazil)/$30,779 (India) payer perspective: $2336 (UK)/$7122 (USA)/$2239 (NL)/$665 (China)/$586 (Brazil)/$369 (India) |
societal perspective: cost-saving in HIC (UK-ICER = $5639/QALY; USA-ICER = $4018/QALY; Netherlands-ICER = $11,433/QALY); appears cost-effective in UMIC (China-ICER = $18,066/QALY; Brazil-ICER = $13,579/QALY); not cost-effective in LMIC (India-ICER = $23,031/QALY). payer perspective: highly cost-effective in HIC (UK-ICER = $21,191/QALY, USA-ICER = $16,552/QALY, Netherlands-ICER = $25,215/QALY); cost-effective in UMIC (China-ICER = $23,485/QALY, Brazil−ICER = $20,995/QALY); not cost-effective in LMIC (India-ICER = $32,217/QALY) |
Population-based BRCA testing can prevent an additional 2319 to 2666 BCE and 327 to 449 OC cases per million women than the current clinical strategy. Findings suggest that population-based BRCA testing for countries evaluated is extremely cost-effective across HIC/UMIC health systems, is cost-saving for HIC health systems from a societal perspective, and can prevent tens of thousands more BC/OC cases |
| Manchanda R et al. [16] | UK, USA | 2019 | Jewish Population | £21,599.96/QALY (UK)/$54,769.78/QALY (USA) | na | na | Sensitivity analyses demonstrated that population testing remained cost-effective over 84% and 93% of simulations for UK and US health systems, respectively |
| Zhang L et al. [19] | Australia | 2019 | Preventive population genomic screening to all adults aged 18–25 years in Australia, assuming a 71% testing uptake, compared with current estimated rates of targeted testing (15% for cancer gene testing and 5% for preconception carrier screening) | AUD$12,973 ($8532 to $19,759]/DALYa prevented) | AUD$200 to $1200 per test | AUD$651(448–865) million | Screening would prevent an estimated 73,728 (53,303 to 104,266) DALYs and save AUD$311 million ($168 to $517 million) in treatment costs through prevention, for a net health system cost of AUD$302 million ($0 to $573 million), above current expenditure |
| Kemp Z et al. [22] | UK, Malaysia | 2019 | HBOC patients (mainstream | MGC Criteria: $59,746 (testing)/MCG Plus Criteria: $73,792 (testing) | MGC Criteria: $57,691 (no testing)/MCG Plus Criteria: $71,046 (no testing) |
Test: MCG Criteria: $175, 259.610 ($1330 per QALYs)/MCG Plus Criteria: $193,587.091 ($1225 per QALYs) NO Test: $172,525.741 ($1330 per QALYs)/MCG Plus Criteria: $190,223.417 ($1225 per QALYs) |
With use of the MCG criteria, the model estimates that 804 cancers and 161 deaths would be prevented per year of testing over the subsequent 50 years. With use of the MCG plus criteria, 1020 cancers and 204 deaths are estimated to be prevented per year over 50 years |
| Sun L. et al. [43] | USA, UK | 2019 | All patients with BC (strategy A) compared with the current practice of BRCA testing using clinical- or FH-based criteria (≥10% pathogenic variant risk) (strategy B). | £18,772/LYGs (UK)/$18,652/LYGs (USA) | £18,755/LYGs (UK)/$18,639/LYGs (USA) | £11,817/LYGs(UK)/ | Strategy A was associated with an additional 419-day increase in life expectancy for UK and 298 days for US BRCA1/BRCA2/PALB2 pathogenic variant carriers |
| Norum J. et al. [44] | Norway | 2018 | Patients with FH vs all patients with BC | € 17.84 | € 13.33 | €40,503 for Life Years gained (LYG) | Diagnostic BRCA testing of all patients with BC was superior to the FH approach and cost-effective within the frequently used thresholds (healthcare perspective) in Norway (€60 000–€80 000/LYG) |
a
DALY: one DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost due to premature mortality (YLLs) and the years lived with a disability (YLDs) due to prevalent cases of the disease or health condition in a population (World Health Organization definition).