BRCA mutation carrier detection. A model-based cost-effectiveness analysis comparing the traditional family history approach and the testing of all patients with breast cancer

Jan Norum; Eli Marie Grindedal; Cecilie Heramb; Inga Karsrud; Sarah Louise Ariansen; Dag Erik Undlien; Ellen Schlichting; Lovise Mæhle

doi:10.1136/esmoopen-2018-000328

BRCA mutation carrier detection. A model-based cost-effectiveness analysis comparing the traditional family history approach and the testing of all patients with breast cancer

ESMO Open. 2018 Apr 13;3(3):e000328. doi: 10.1136/esmoopen-2018-000328. eCollection 2018.

Authors

Jan Norum¹, Eli Marie Grindedal², Cecilie Heramb³, Inga Karsrud⁴, Sarah Louise Ariansen³, Dag Erik Undlien⁴, Ellen Schlichting⁴, Lovise Mæhle³

Affiliations

¹ Department of Surgery, Finnmark Hospital, Hammerfest, Norway.
² Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.
³ Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway.
⁴ Section for Breast and Endocrine Surgery, Department of Cancer, Oslo University Hospital, Oslo, Norway.

Abstract

Background: Identification of BRCA mutation carriers among patients with breast cancer (BC) involves costs and gains. Testing has been performed according to international guidelines, focusing on family history (FH) of breast and/or ovarian cancer. An alternative is testing all patients with BC employing sequencing of the BRCA genes and Multiplex Ligation Probe Amplification (MLPA).

Patients and methods: A model-based cost-effectiveness analysis, employing data from Oslo University Hospital, Ullevål (OUH-U) and a decision tree, was done. The societal and the healthcare perspectives were focused and a lifetime perspective employed. The comparators were the traditional FH approach used as standard of care at OUH-U in 2013 and the intervention (testing all patients with BC) performed in 2014 and 2015 at the same hospital. During the latter period, 535 patients with BC were offered BRCA testing with sequencing and MLPA. National 2014 data on mortality rates and costs were implemented, a 3% discount rate used and the costing year was 2015. The incremental cost-effectiveness ratio was calculated in euros (€) per life-year gained (LYG).

Results: The net healthcare cost (healthcare perspective) was €40 503/LYG. Including all resource use (societal perspective), the cost was €5669/LYG. The univariate sensitivity analysis documented the unit cost of the BRCA test and the number of LYGs the prominent parameters affecting the result.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).

Keywords: BRCA mutation; Norway; breast cancer; cost; testing.