Author(s)
Guzauskas G1, Garbett S2, Zhou Z2, Spencer S3, Smith H4, Hao J5, Snyder S6, Graves J7, Peterson J7, Williams M8, Veenstra DL3
1Vanderbilt University, Seattle, WA, USA, 2Vanderbilt University, Nashville, TN, USA, 3University of Washington, Seattle, WA, USA, 4Baylor College of Medicine, Houston, TX, USA, 5Geisinger Department of Population Health Sciences, Danville, PA, USA, 6Geisinger Department of Epidemiology and Health Services Research, Danville, PA, USA, 7Vanderbilt University Medical Center, Nashville, TN, USA, 8Geisinger, Danville, PA, USA
OBJECTIVES. Previous economic analyses of population screening for hereditary breast and ovarian cancer (HBOC) have not considered cascade testing, wherein newly identified carriers spur family members to undergo genetic testing. We developed an approach to model cascade testing based on results of a standalone population screening model and estimated the impact of combining their incremental results. METHODS. We used a decision tree approach to model key elements of cascade testing. We used data on living female relatives from the Panel Study of Income Dynamics and derived other model parameters from a literature review of family communication studies. We used the population screening model to estimate age-based incremental costs and QALYs for newly identified HBOC carriers, then calculated dynamic weighted averages of incremental outcomes for carriers’ surviving female relatives in the cascade testing model. We then combined results to derive overall population screening plus cascade testing costs and outcomes. RESULTS. The incremental cost and QALYs of cascade testing per newly identified carrier ranged from $560 to $1,420 and 0.002 to 0.064, respectively, depending on the newly identified carrier’s age and surviving family members. At the population level, the incremental impacts of cascade testing were modest given the low prevalence of HBOC variants (~0.5%) and the low uptake of testing by informed family members (~20%); for an unselected population of 30-year-olds, adding cascade testing to the population screening model lowered the overall incremental cost-effectiveness ratio from $145,000 to $131,000 . Threshold analyses showed at least 43% of cascade testing uptake was required to achieve combined ICERs below $100,000. CONCLUSIONS. Population screening for HBOC may be moderately cost-effective and adding cascade testing slightly improved its overall cost-effectiveness. Ultimately, the value of HBOC screening within the general population and cascade testing should be assessed within the context of a broader multiplex screening panel.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
Value in Health, Volume 23, Issue 5, S1 (May 2020)
Code
PCN176
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory, Methodological & Statistical Research
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Public Health, Public Spending & National Health Expenditures
Disease
Oncology, Personalized and Precision Medicine
