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406 Population-based BRCA1 and BRCA2 testing in Canada: an economic evaluation
  1. Li Sun1,
  2. Xia Wei1,2,
  3. Caitlin T Fierheller2,
  4. Lesa Dawson3,
  5. Samuel Oxley2,4,
  6. Ashwin Kalra2,4,
  7. Jacqueline Sia2,4,
  8. Fabio Feldman5,
  9. Stuart Peacock6,7,
  10. Kasmintan A Schrader3,5,
  11. Rosa Legood1,2,
  12. Janice Kwon3 and
  13. Ranjit Manchanda1,2,8,9
  1. 1London School of Hygiene & Tropical Medicine, London, United Kingdom
  2. 2Queen Mary University of London, London, United Kingdom
  3. 3University of British Columbia, Vancouver, Canada
  4. 4Barts Health NHS Trust, London, United Kingdom
  5. 5BC Cancer Agency, Vancouver, Canada
  6. 6Simon Fraser University, Burnaby, Canada
  7. 7Canadian Centre for Applied Research in Cancer Control, Vancouver, Canada
  8. 8Barts and the Royal London Hospital, London, United Kingdom
  9. 9University College London, London, United Kingdom


Introduction/Background Cost-effectiveness of population-based BRCA-testing has not been assessed in the Canadian population. Population-based BRCA-testing can identify many more BRCA-carriers who will be missed by the current practice of family-history (FH) based BRCA-testing and can benefit from screening and prevention. This study aims to estimate the incremental lifetime health effects, costs, and cost-effectiveness of population-based BRCA-testing compared with family-history based testing in Canada.

Methodology A Markov-model was developed to compare the lifetime costs and effects of BRCA1/BRCA2-testing all general population women over 30-years compared with FH-based testing. BRCA-carriers are offered risk-reducing salpingo-oophorectomy to reduce their ovarian cancer (OC) risk and MRI/mammography-screening/medical prevention/risk-reducing mastectomy to reduce their breast cancer (BC) risk. Outcomes include OC, BC, and additional heart disease deaths and incremental cost-effectiveness ratio (ICER)/quality-adjusted life-year (QALY). The analyses were conducted from both payer and societal perspectives. One-way and probabilistic sensitivity analyses (PSA) were undertaken to explore the uncertainty.

Results The base case ICERs of population-based BRCA-testing were $32,276/QALY (payer) or $16,416/QALY (societal) compared to FH-based testing, well below the Canadian cost-effectiveness thresholds. The results were robust for multiple scenarios, one-way sensitivity, and PSA. >99% simulations from payer and societal perspectives were cost-effective on PSA at the $50,000/QALY willingness-to-pay threshold. Population-based BRCA-testing could potentially prevent additional 32,841 BC cases and 6,387 OC cases in the Canadian population, corresponding to averting 2,516 BC deaths and 2,103 OC deaths during a lifetime horizon.

Conclusion Population-based BRCA-testing is cost-effective in Canada from payer and societal perspectives. This can prevent 39,228 more breast/ovarian cancer cases and 4,619 breast/ovarian cancer deaths across the population. Our results call for implementation studies in Canada.

Disclosures RM has been supported by an NHS Innovation Accelerator Fellowship for population testing. RM declares research funding from The Eve Appeal, Cancer Research UK, Barts & the London Charity, GSK outside this work, as well as an honorarium for advisory board membership for MSD/GSK/Astrazeneca/EGL.

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