Abstract
BackgroundThis study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore.MethodsA Markov model was used to compare the costs and health outcomes of the current screening programme, against a polygenic risk-tailored screening programme, which can advise a long-term screening strategy depending on the individual’s polygenic risk. The model took the perspective of the healthcare system, with a time horizon of 40 years, following women from the age of 35 to 74. Epidemiological and cost data were taken from Asian studies, and an annual discount rate of 3% was used. The model outcome was the incremental cost-effectiveness ratio (ICER), calculated from the difference in costs per quality-adjusted life year (QALY). Scenarios with varying risk thresholds for each polygenic risk group were examined. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty.ResultsThe ICER for a polygenic risk-tailored breast cancer screening programme, compared with the current biennial mammogram-only screening programme, was − 3713.80 SGD/QALY, with incremental costs < 0 and incremental effects > 0. The scenario analysis of different polygenic risk cutoffs showed that the ICERs remain negative, with all ICERs falling within the south-east quadrant of the cost-effectiveness plane, indicating that tailored screening is more cost effective than mammogram-only screening, with lower costs and higher QALYs to be gained. This suggests that a polygenic risk-tailored breast cancer screening programme is cost effective, entailing lower cost than the current mammogram-only programme, while causing no additional harm to women.ConclusionResults from this cost-effectiveness analysis show that polygenic risk-tailored screening is cost effective with an ICER of − 3713.80 SGD/QALY. Tailored screening remains cost effective even across varying percentile cutoffs for each risk group. While the results look promising for incorporating polygenic risk into the current breast cancer screening programme, further studies should be conducted to address various limitations.
Highlights
This study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore
The tailored screening programme is cheaper by SGD3,670.83, resulting in an incremental cost-effectiveness ratio (ICER) of − 3713.80 Singapore Dollars (SGD)/quality-adjusted life year (QALY) (Table 2)
Three scenarios with different percentile cutoffs were explored with splits of 60 L-30I-10H, 40 L-55I-5H, 40 L50I-10H, giving ICERs of − 2300, − 1536, − 74 SGD/ QALY, respectively
Summary
This study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore. Breast cancer is the most prevalent cancer among women globally. In 2018 alone, approximately two million new cases of breast cancer were diagnosed, accounting for 11.6% of all cancers, resulting in more than 626, 000 deaths [1]. As with the global trend, breast cancer is the most common cancer among women in Singapore, accounting for 29.1% of all cancer diagnoses. In the 5-year period of 2011–2015, a total of 9634 new cases of breast cancer were diagnosed. There were 3136 new cases of breast cancer in 2018 alone [3]. Breast cancer is consistently the cancer type with the highest number of fatalities, accounting for 2105 women in the period of 2011–2015 [2]. It is imperative that a screening programme considers all these factors and screens for breast cancer promptly and effectively
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