PMID- 28690137
OWN - NLM
STAT- MEDLINE
DCOM- 20171116
LR  - 20180502
IS  - 1097-6868 (Electronic)
IS  - 0002-9378 (Linking)
VI  - 217
IP  - 5
DP  - 2017 Nov
TI  - Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish
      ancestry.
PG  - 578.e1-578.e12
LID - S0002-9378(17)30842-6 [pii]
LID - 10.1016/j.ajog.2017.06.038 [doi]
AB  - BACKGROUND: Population-based BRCA1/BRCA2 testing has been found to be
      cost-effective compared with family history-based testing in Ashkenazi-Jewish
      women were >30 years old with 4 Ashkenazi-Jewish grandparents. However,
      individuals may have 1, 2, or 3 Ashkenazi-Jewish grandparents, and
      cost-effectiveness data are lacking at these lower BRCA prevalence estimates. We 
      present an updated cost-effectiveness analysis of population BRCA1/BRCA2 testing 
      for women with 1, 2, and 3 Ashkenazi-Jewish grandparents. STUDY DESIGN: Decision 
      analysis model. METHODS: Lifetime costs and effects of population and family
      history-based testing were compared with the use of a decision analysis model.
      56% BRCA carriers are missed by family history criteria alone. Analyses were
      conducted for United Kingdom and United States populations. Model parameters were
      obtained from the Genetic Cancer Prediction through Population Screening trial
      and published literature. Model parameters and BRCA population prevalence for
      individuals with 3, 2, or 1 Ashkenazi-Jewish grandparent were adjusted for the
      relative frequency of BRCA mutations in the Ashkenazi-Jewish and general
      populations. Incremental cost-effectiveness ratios were calculated for all
      Ashkenazi-Jewish grandparent scenarios. Costs, along with outcomes, were
      discounted at 3.5%. The time horizon of the analysis is "life-time," and
      perspective is "payer." Probabilistic sensitivity analysis evaluated model
      uncertainty. RESULTS: Population testing for BRCA mutations is cost-saving in
      Ashkenazi-Jewish women with 2, 3, or 4 grandparents (22-33 days life-gained) in
      the United Kingdom and 1, 2, 3, or 4 grandparents (12-26 days life-gained) in the
      United States populations, respectively. It is also extremely cost-effective in
      women in the United Kingdom with just 1 Ashkenazi-Jewish grandparent with an
      incremental cost-effectiveness ratio of pound863 per quality-adjusted life-years 
      and 15 days life gained. Results show that population-testing remains
      cost-effective at the pound20,000-30000 per quality-adjusted life-years and
      $100,000 per quality-adjusted life-years willingness-to-pay thresholds for all 4 
      Ashkenazi-Jewish grandparent scenarios, with >/=95% simulations found to be
      cost-effective on probabilistic sensitivity analysis. Population-testing remains 
      cost-effective in the absence of reduction in breast cancer risk from
      oophorectomy and at lower risk-reducing mastectomy (13%) or risk-reducing
      salpingo-oophorectomy (20%) rates. CONCLUSION: Population testing for BRCA
      mutations with varying levels of Ashkenazi-Jewish ancestry is cost-effective in
      the United Kingdom and the United States. These results support population
      testing in Ashkenazi-Jewish women with 1-4 Ashkenazi-Jewish grandparent ancestry.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Manchanda, Ranjit
AU  - Manchanda R
AD  - Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary
      University of London, London, UK; Department of Gynaecological Oncology, Barts
      Health NHS Trust, Royal London Hospital, London, UK; Gynaecological Cancer
      Research Centre, Department of Women's Cancer, Institute for Women's Health,
      University College London, London, UK. Electronic address:
      r.manchanda@qmul.ac.uk.
FAU - Patel, Shreeya
AU  - Patel S
AD  - Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary
      University of London, London, UK; Department of Health Services Research and
      Policy, London School of Hygiene and Tropical Medicine, London, UK.
FAU - Antoniou, Antonis C
AU  - Antoniou AC
AD  - Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways
      Research Laboratory, Worts Causeway, Cambridge, UK.
FAU - Levy-Lahad, Ephrat
AU  - Levy-Lahad E
AD  - Medical Genetics Institute, Shaare Zedek Hospital, Jerusalem, Israel.
FAU - Turnbull, Clare
AU  - Turnbull C
AD  - Barts Cancer Institute, Queen Mary University of London, London, UK.
FAU - Evans, D Gareth
AU  - Evans DG
AD  - Centre for Genomic Medicine, Division of Evolution and Genomic science,
      University of Manchester, Manchester, UK.
FAU - Hopper, John L
AU  - Hopper JL
AD  - Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global 
      Health, Faculty of Medicine, Dentistry & Health Sciences, University of
      Melbourne, Victoria, Australia.
FAU - Macinnis, Robert J
AU  - Macinnis RJ
AD  - Cancer Epidemiology & Intelligence Division, Cancer Council Victoria, Melbourne, 
      Victoria, Australia.
FAU - Menon, Usha
AU  - Menon U
AD  - Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute
      for Women's Health, University College London, London, UK.
FAU - Jacobs, Ian
AU  - Jacobs I
AD  - University of New South Wales, UNSW Sydney NSW.
FAU - Legood, Rosa
AU  - Legood R
AD  - Department of Health Services Research and Policy, London School of Hygiene and
      Tropical Medicine, London, UK.
LA  - eng
GR  - G0700491/Medical Research Council/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170706
PL  - United States
TA  - Am J Obstet Gynecol
JT  - American journal of obstetrics and gynecology
JID - 0370476
SB  - AIM
SB  - IM
MH  - Adult
MH  - Cost-Benefit Analysis
MH  - Decision Support Techniques
MH  - Female
MH  - *Genes, BRCA1
MH  - *Genes, BRCA2
MH  - Genetic Testing/*economics/methods
MH  - Grandparents
MH  - *Health Care Costs
MH  - Hereditary Breast and Ovarian Cancer Syndrome/*diagnosis/economics/genetics
MH  - Humans
MH  - Jews/*genetics
MH  - Medical History Taking
MH  - Ovariectomy/economics
MH  - Prophylactic Mastectomy/economics
MH  - Prophylactic Surgical Procedures/economics
MH  - *Quality-Adjusted Life Years
MH  - Salpingectomy/economics
MH  - United Kingdom
MH  - United States
OTO - NOTNLM
OT  - *Ashkenazi Jewish
OT  - *BRCA
OT  - *ancestry
OT  - *cost-effectiveness
OT  - *population testing
EDAT- 2017/07/12 06:00
MHDA- 2017/11/29 06:00
CRDT- 2017/07/11 06:00
PHST- 2017/05/11 00:00 [received]
PHST- 2017/06/22 00:00 [revised]
PHST- 2017/06/30 00:00 [accepted]
PHST- 2017/07/12 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2017/07/11 06:00 [entrez]
AID - S0002-9378(17)30842-6 [pii]
AID - 10.1016/j.ajog.2017.06.038 [doi]
PST - ppublish
SO  - Am J Obstet Gynecol. 2017 Nov;217(5):578.e1-578.e12. doi:
      10.1016/j.ajog.2017.06.038. Epub 2017 Jul 6.