Cost-Effectiveness of Population-Based Risk Assessment and Hereditary Cancer Genetic Testing in Primary Care
Author(s)
HuiHsuan Chan, MHS1, Beth Devine, MBA, PharmD, PhD2;
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Student, Seattle, WA, USA, 2The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, University of Washington, Seattle, WA, USA
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Student, Seattle, WA, USA, 2The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, University of Washington, Seattle, WA, USA
Presentation Documents
OBJECTIVES: To estimate the incremental cost effectiveness ratio (ICER) between two, primary care-based population engagement risk-screening and genetic testing strategies to identify the numbers of individuals at high risk for hereditary cancers, and subsequently testing those individuals.
METHODS: We constructed a decision-analytic cohort model and compared an in-clinic point of care (POC) screening strategy to a direct patient engagement (DPE) strategy that involved (e)mailing screening invitations after a visit. At risk participants were offered complementary genetic testing. Data were obtained from the EDGE (Early Detection of GEnetic risk)-clinic-randomized controlled trial that evaluated these two engagement strategies. We modeled testing all clinic patients over a two-year timeframe and present results from both health-system and limited societal perspectives. Outcomes were the number of patients screened and tested, the costs for each strategy, and the ICERs.
RESULTS: From the health-system perspective, costs for approaching 100,000 patients were $641,278 (POC) and $702,653 (DPE). The POC strategy led to 14,490 patients completing risk assessment and the DPE strategy to 6,385 patients, thus POC dominated DPE for risk assessment completion (65% of simulations). The POC strategy led to fewer individuals completing testing than the DPE strategy (780 vs. 1,184), revealing an ICER of $152 (health-system) and $136 (limited societal) perspectives slightly in favor of DPE (52% of simulations). Results from the limited societal perspective were similar. With substantial uncertainty, results suggest that the DPE strategy may provide good value for money spent on testing at a willingness-to-pay test-kit cost of $250.
CONCLUSIONS: That POC led to more patients completing risk assessment while DPE led to more patients completing testing suggests that engagement approaches play an important role in shaping outcomes of population-based risk assessments. A hybrid approach (DPE, followed by POC for those who do not respond) may be optimal.
METHODS: We constructed a decision-analytic cohort model and compared an in-clinic point of care (POC) screening strategy to a direct patient engagement (DPE) strategy that involved (e)mailing screening invitations after a visit. At risk participants were offered complementary genetic testing. Data were obtained from the EDGE (Early Detection of GEnetic risk)-clinic-randomized controlled trial that evaluated these two engagement strategies. We modeled testing all clinic patients over a two-year timeframe and present results from both health-system and limited societal perspectives. Outcomes were the number of patients screened and tested, the costs for each strategy, and the ICERs.
RESULTS: From the health-system perspective, costs for approaching 100,000 patients were $641,278 (POC) and $702,653 (DPE). The POC strategy led to 14,490 patients completing risk assessment and the DPE strategy to 6,385 patients, thus POC dominated DPE for risk assessment completion (65% of simulations). The POC strategy led to fewer individuals completing testing than the DPE strategy (780 vs. 1,184), revealing an ICER of $152 (health-system) and $136 (limited societal) perspectives slightly in favor of DPE (52% of simulations). Results from the limited societal perspective were similar. With substantial uncertainty, results suggest that the DPE strategy may provide good value for money spent on testing at a willingness-to-pay test-kit cost of $250.
CONCLUSIONS: That POC led to more patients completing risk assessment while DPE led to more patients completing testing suggests that engagement approaches play an important role in shaping outcomes of population-based risk assessments. A hybrid approach (DPE, followed by POC for those who do not respond) may be optimal.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE356
Topic
Economic Evaluation
Disease
SDC: Oncology