| Title |
Cost-effectiveness of population based BRCA testing with varying Ashkenazi Jewish ancestry
|
|---|---|
| Published in |
American Journal of Obstetrics & Gynecology, July 2017
|
| DOI | 10.1016/j.ajog.2017.06.038 |
| Pubmed ID | |
| Authors |
Ranjit Manchanda, Shreeya Patel, Antonis C. Antoniou, Ephrat Levy-Lahad, Clare Turnbull, D. Gareth Evans, John L. Hopper, Robert J. Macinnis, Usha Menon, Ian Jacobs, Rosa Legood |
| Abstract |
Population based BRCA1/BRCA2 testing has been found to be cost-effective compared to family-history based testing in Ashkenazi-Jewish (AJ) women >30years with four AJ-grandparents. However, individuals may have one, two or three AJ 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 one, two and three AJ grandparents. Life time costs and effects of population and family-history based testing were compared using a decision analysis model. 56% BRCA carriers are missed by family-history criteria alone. Analyses are conducted for UK and USA populations. Model parameters are obtained from the GCaPPS trial and published literature. Model parameters and BRCA population prevalence for individuals with three, two or one AJ grandparents are adjusted for the relative frequency of BRCA mutations in the AJ and general populations. Incremental cost-effectiveness ratios were calculated for all AJ-grandparent scenarios. Costs along with outcomes discounted at 3.5%. The time horizon of the analysis is 'life-time' and perspective is 'payer'. Probabilistic sensitivity-analysis (PSA) evaluated model uncertainty. Population testing for BRCA mutations is cost saving in AJ women with two, three or four grandparents (22-33 days life-gained) in UK and one, two, three or four grandparents (12-26 days life-gained) in USA populations respectively. It is also extremely cost-effective in UK women with just one AJ-grandparent with an incremental-cost-effectiveness-ratio (ICER)= £863/QALY and 15days life-gained. Results show that population-testing remains cost-effective at the £20,000-30000/QALY and $100,000/QALY willingness-to-pay thresholds for all four AJ-grandparent scenarios with ≥95% simulations found to be cost-effective on PSA. Population-testing remains cost-effective in the absence of reduction in breast cancer risk from oophorectomy and at lower RRM (13%)/RRSO (20%) rates. Population-testing for BRCA mutations is cost-effective in the UK and USA with varying levels of AJ ancestry. These results support population testing in AJ women with 1-4 AJ-grandparent ancestry. |
Mendeley readers
The data shown below were compiled from readership statistics for 110 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 110 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 15 | 14% |
| Researcher | 13 | 12% |
| Student > Master | 10 | 9% |
| Student > Doctoral Student | 9 | 8% |
| Student > Bachelor | 8 | 7% |
| Other | 21 | 19% |
| Unknown | 34 | 31% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 23 | 21% |
| Nursing and Health Professions | 9 | 8% |
| Biochemistry, Genetics and Molecular Biology | 7 | 6% |
| Agricultural and Biological Sciences | 5 | 5% |
| Social Sciences | 5 | 5% |
| Other | 17 | 15% |
| Unknown | 44 | 40% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. 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 14 March 2019.
All research outputs
#4,947,179
of 25,806,080 outputs
Outputs from American Journal of Obstetrics & Gynecology
#4,091
of 13,410 outputs
Outputs of similar age
#78,806
of 327,116 outputs
Outputs of similar age from American Journal of Obstetrics & Gynecology
#69
of 103 outputs
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