Abstract
BackgroundNearly 56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. The present study aims to review the economic evaluation studies on BRCA genetic testing strategies for screening and early detection of breast cancer.MethodsThis systematic literature review is conducted within the Cochrane Library, PubMed, Scopus, Web of Science, ProQuest, and EMBASE databases. In this paper, the relevant published economic evaluation studies are identified by following the standard Cochrane Collaboration methods and adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement reporting some recommendations for articles up to March 2020. Thereafter, the inclusion and exclusion criteria are applied to screen the articles. Disagreements are resolved through a consensus meeting. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist is used in the evaluation of quality. Finally, a narrative synthesis is performed. To compare the different levels of incremental cost-effectiveness ratio (ICER), the net present value is calculated based on a discount rate of 3% in 2019.ResultsAmong 788 initially retrieved citations, 12 studies were included. More than 60% of the studies were originated from high-income countries and were published after 2016. It is noteworthy that most of the studies evaluated the payer perspective. Moreover, the robustness of the results were analyzed through one-way and probabilistic sensitivity analyses in nearly 66% of these studies. Nearly, 25% of the studies are focused and defined population-based and family history BRCA tests as comparators; afterwards, the cost-effectiveness of the former was confirmed. The highest and lowest absolute values for the ICERs were $65,661 and $9 per quality adjusted life years, respectively. All studies met over 70% of the CHEERs criteria checklist, which was considered as 93% of high quality on average as well.ConclusionsThe genetic BRCA tests for the general population as well as unselected breast cancer patients were cost-effective in high and upper-middle income countries and those with prevalence of gene mutation while population-based genetic tests for low-middle income countries are depended on the price of the tests.
Highlights
56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing
The current study reviewed 12 published economic evaluation studies conducted on the genetic tests for screening as well as early detection of breast cancer
The genetic BRCA tests are considered as cost-effective methods for the general population as well as unselected breast cancer patients in high and upper-middle-income countries, in which the prevalence of gene mutation is high
Summary
56% of at-risk carriers are not identified and missed as a result of the current family-history (FH) screening for genetic testing. Several studies have focused on the treatment costs of breast cancer. Based on Allaire et al study, the treatment excess1cost of the disease for stages I to III/IV was ranged from $72,177 to $131,812 for women between 21 and years old; while it was ranged from $53,288 to $124,237 for women between and 64 years old within months (from 2003 to 2010) in the North Carolina cancer registry, respectively. Higher breast cancer treatment costs for young women were attributed to higher prevalence as well as later-stage disease [5]. The minimum, maximum, and average direct medical costs of the disease in Italy were estimated at €6692, €12,825, and €10,970 between 2007 and 2011, respectively which the higher one was related to metastatic patients [6]. The highest expenditure was related to stage IV [7] All of these studies demonstrated that breast cancer treatment costs were increased in advanced stages constantly; it can be reduced by early detection
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