Homepage > Research abstracts > Cost-utility analysis of universal screening for common BRCA1 and BRCA2 mutations among Ashkenazi Jewish women in Israel
Cost-utility analysis of universal screening for common BRCA1 and BRCA2 mutations among Ashkenazi Jewish women in Israel
Researchers: Ephrat Levy-Lahad1,2
- Shaare Zedek Medical Center
- Hebrew University of Jerusalem
Background: Testing for common BRCA1/BRCA2 mutations found in 2.5% of Ashkenazi Jews (AJ) fulfills WHO criteria for disease screening, but the cost-effectiveness of this policy in Israel has yet to be determined. If unaffected carriers, who face high breast/ovarian cancer risks, are identified pre-symptomatically they can reduce morbidity and mortality through surveillance and prevention measures. However, the National Health List of Services covers BRCA testing in unaffected women only if there is a known familial mutation. Wider testing strategies, e.g., population screening (PS), may be warranted if found to be cost-effective.
Objectives: Analyze the cost-effectiveness of BRCA1/BRCA2 PS in AJ, vs. existing testing strategies:
1. Israel Ministry of Health (IMOH) policy (25% carrier probability).
2. International FH (IFH)-based guidelines (FH indicating >10% carrier probability).
1. Israel Ministry of Health (IMOH) policy (25% carrier probability).
2. International FH (IFH)-based guidelines (FH indicating >10% carrier probability).
Method: We used a decision-tree to estimate screening and treatment costs, life years and quality-adjusted life years (QALY) gained, and the incremental cost-effectiveness ratio (ICER) for PS and IFH vs. the current IMOH policy. We also estimated the budget impact of PS.
Findings: IFH and PS strategies were both more effective and cost-saving (dominant) compared to the IMOH policy, with ICERs/QALY of -78,773 NIS (-22,065 USD) and -11,055 NIS (-3097 USD), respectively. For IFH and PS respectively, the model predicted 3.6 and 7-day gains in lifespan, and reductions of 0.2% and 0.3% in breast cancer events and 0.3% and 0.4% in ovarian cancer events. PS was sensitive to uptake and effectiveness of prevention measures and to costs of surveillance. IFH strategy was sensitive to carrier prevalence among those tested, to cancer risks in carriers and cost of cancer care.
Conclusions: PS has the highest effectiveness for breast/ovarian cancer prevention in BRCA carriers and dominates the IMOH policy.
Recommendations: Common BRCA mutation testing should be available to all AJ women irrespective of family history
Research number: A/93/2017
Research end date: 08/2019