| Title |
Cost effectiveness of population based BRCA1 founder mutation testing in Sephardi Jewish women
|
|---|---|
| Published in |
American Journal of Obstetrics & Gynecology, December 2017
|
| DOI | 10.1016/j.ajog.2017.12.221 |
| Pubmed ID | |
| Authors |
Shreeya Patel, Rosa Legood, D. Gareth Evans, Clare Turnbull, Antonis C. Antoniou, Usha Menon, Ian Jacobs, Ranjit Manchanda |
| Abstract |
Population-based BRCA1/BRCA2 founder-mutation testing has been demonstrated as cost-effective compared to family-history(FH) based testing in Ashkenazi Jewish(AJ) women. However, only one of the three AJ BRCA1/BRCA2 founder-mutations (185delAG(c.68_69delAG), 5382insC(c.5266dupC) and 6174delT(c.5946delT)) is found in the Sephardi Jewish(SJ) population (185delAG(c.68_69delAG)) and the overall prevalence of BRCA mutations in the SJ population is accordingly lower (0.7% compared to 2.5% in the AJ population). Cost-effectiveness analyses of BRCA testing have not previously been performed at these lower BRCA prevalence levels seen in SJ. Here we present a cost-effectiveness analysis for UK and US populations comparing population-testing with Clinical-criteria/FH-based testing in SJ women. A Markov model was built comparing the lifetime costs-&-effects of population-based BRCA1-testing with testing using FH-based clinical criteria in SJ women ≥30years. BRCA1-carriers identified were offered MRI/mammograms and risk-reducing surgery. Costs are reported at 2015 prices. Outcomes include breast cancer(BC), ovarian cancer(OC) and excess deaths from heart disease. All costs-&-outcomes are discounted at 3.5%. The time horizon is life-time, and perspective is payer. The incremental-cost-effectiveness-ratio (ICER) per quality-adjusted life-year (QALY) was calculated. Parameter uncertainty was evaluated through one-way and probabilistic-sensitivity-analysis (PSA). Population-testing resulted in gain in life-expectancy of 12months (QALY=1.00). The baseline discounted ICER for UK population-based testing =£67.04/QALY and for US population=$308.42/QALY. Results were robust in the one-way sensitivity analysis. The PSA showed 100% of simulations were cost-effective at £20,000/QALY UK and the $100,000/QALY US WTP thresholds. Scenario analysis showed, population-testing remains cost-effective in UK and US populations even if pre-menopausal oophorectomy does not reduce BC-risk or if hormone-replacement-therapy compliance is nil. Population-based BRCA1- testing is highly cost-effective compared to clinical-criteria driven approach in SJ women. This supports changing the paradigm to population-based BRCA- testing in the Jewish population regardless of Ashkenazi/Sephardi ancestry. |
X Demographics
The data shown below were collected from the profiles of 13 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 23% |
| United States | 2 | 15% |
| Spain | 1 | 8% |
| Argentina | 1 | 8% |
| Netherlands | 1 | 8% |
| Unknown | 5 | 38% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 10 | 77% |
| Scientists | 2 | 15% |
| Practitioners (doctors, other healthcare professionals) | 1 | 8% |
Mendeley readers
The data shown below were compiled from readership statistics for 83 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 83 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 9 | 11% |
| Researcher | 7 | 8% |
| Other | 7 | 8% |
| Student > Bachelor | 7 | 8% |
| Student > Ph. D. Student | 6 | 7% |
| Other | 17 | 20% |
| Unknown | 30 | 36% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 15 | 18% |
| Nursing and Health Professions | 6 | 7% |
| Biochemistry, Genetics and Molecular Biology | 6 | 7% |
| Pharmacology, Toxicology and Pharmaceutical Science | 5 | 6% |
| Unspecified | 4 | 5% |
| Other | 11 | 13% |
| Unknown | 36 | 43% |
Attention Score in Context
This research output has an Altmetric Attention Score of 8. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 April 2018.
All research outputs
#4,942,752
of 25,806,080 outputs
Outputs from American Journal of Obstetrics & Gynecology
#4,085
of 13,410 outputs
Outputs of similar age
#97,962
of 451,806 outputs
Outputs of similar age from American Journal of Obstetrics & Gynecology
#119
of 314 outputs
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