Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China.

BACKGROUND

The women's cancer screening program has been operational for several years in China, primarily utilizing palpation and ultrasound. Given the proven impact of BRCA1/2 mutations on the incidence of breast and ovarian cancer, the cost-effectiveness of incorporating BRCA1/2 mutation testing into these programs, either for the entire population or through enrichment based on family history of breast and ovarian cancer, remains poorly researched.

METHODS

We constructed a decision tree model to compare the cost-effectiveness of three strategies: symptom-based screening only (Symptom-only strategy), population-based BRCA1/2 testing (population-based strategy), and family-history-based BRCA1/2 testing (FH-based strategy). One-way and probability sensitivity analyses enabled model uncertainty evaluation. Outcomes included early and advanced stages of ovarian and breast cancer. Cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. The target population was women at 40-60 years, the time horizon was until age 70, and the perspective was payer-based.

RESULTS

The FH-based strategy was found to be cost-effective compared to the Symptom-only strategy (ICER: ¥185,710/QALY, gaining 0.26 days' life expectancy). Its cost-effectiveness was significantly influenced by the risks of ovarian and breast cancer among BRCA1/2 carriers, the prevalence of BRCA1/2 mutations in the general Chinese population, the prevalence of family history of breast and ovarian cancer among Chinese women, and the prevalence of BRCA1/2 mutations in the FH-positive population. Integrating these variable distributions, the FH-based strategy showed a 76.96% probability of cost-effectiveness. The Population-based strategy was not cost-effective, whether compared to the Symptom-only strategy (ICER: ¥504,476/QALY, gaining 2.66 days' life expectancy) or to the FH-based strategy (ICER: ¥539,476/QALY, gaining 2.41 days' life expectancy). The prevalence of BRCA1/2 mutations in the general Chinese population was identified as the primary variable affecting its cost-effectiveness. Integrating these variable distributions, the Population-based strategy had a probability of cost-effectiveness of only 0.8%.

CONCLUSION

Incorporating family-history-based BRCA1/2 testing into breast and ovarian cancer screening programs is cost-effective in China and warrants promotion.