Cost Effectiveness of Whole Population BRCA Genetic Screening for Cancer Prevention in Israel

Abstract

With the growing technical ease and reduction in genetic screening costs, whole population BRCA screening may be a feasible option. Our objective was to investigate the cost effectiveness of whole population screening for BRCA mutations in Israel, for varying degrees of BRCA carrier state. Lifetime costs of whole female population screening for BRCA mutation carrier state versus nonscreening were compared using a Markovian process decision analysis model. Model parameters including ovarian and breast cancer risks were obtained from previously published data. Screening and other treatment-related costs were received from the Israeli Ministry of Health pricing list according to specified codes. Quality-adjusted life years were used for cost-effectiveness analysis. Sensitivity analysis was conducted to evaluate model uncertainties, specifically varying degrees of BRCA prevalence. Results show that whole population BRCA screening in Israel is cost effective across a wide range of BRCA prevalence rates with an incremental cost-effectiveness ratio of 81,493 new Israeli Shekels for a BRCA prevalence of 2.5%, increasing to 250,000 new Israeli Shekels for a 0.75% prevalence rate, per quality-adjusted life year gained. Discount rate and population BRCA prevalence and rate of risk reduction salpingo-oophorectomy are the most influential parameters in the model. Whole population screening for BRCA mutations should be offered as part of general health screening strategies by national medical insurance providers, even for non-Ashkenazi Jews. Our algorithm can be applied for other countries, adjusting local costs of screening and treatment. Prevention Relevance: Whole population BRCA mutation screening in Israel is cost effective across a wide prevalence rate and should be offered as part of general health screening strategies by national medical insurance providers for cancer prevention.

Yield of targeted genotyping for the recurring pathogenic variants in cancer susceptibility genes in a healthy, multiethnic Israeli population

“…These rates of germline BRCA1 and BRCA2 pathogenic variants in an unselected Jewish population and particularly the yield of 2.6% in AJs are well established 20,21 and further strengthen the rationale for including targeted BRCA1 / BRCA2 genotyping for all Jewish women, regardless of ethnicity or a family history of cancer 21,22 . Population‐based genotyping in Israel was recently reported to be cost‐effective, 23 as previously shown in the United States and the United Kingdom 21,22 …”

Double Batched DNA Sequencing is a reliable, cost-effective and scalable approach to genomic population screening

“…This is by no means limited to DNA samples from neonatal blood spots. Several studies have investigated the cost-effectiveness of population screening for adult CPSs [18][19][20][21][22] . One such study 22 , investigating the impact of PPS on universal adult screening for BRCA1/2 and MMR genes, found it to be conservatively cost-effective even at PPS exceeding $1000.…”

Overview on population screening for carriers with germline BRCA mutation in China

“…Evidence had shown that relying on personal and family history may not be sufficient to determine the risk for BRCA1/2 variants ( 20 ). Population BRCA screening is considered the trend in the near future ( 124 , 125 ). Thus, a growing number of healthy individuals harboring pathogenic mutations can be identified for cancer prevention.…”