Abstract P4-12-02: Cost-effectiveness of genetic testing with a hereditary cancer panel in women at risk of hereditary breast cancer

Background : The role of the BRCA1/2 genes in breast cancer risk has been well characterized. However, pathogenic variants in additional genes also confer hereditary breast cancer risk and if detected can lead to interventions that can facilitate increased life expectancy. For example, the National Comprehensive Cancer Network (NCCN) guidelines (Version 2.2017) recommend MRI screening for women who carry a pathogenic variant in CHEK2 and MRI screening or risk-reducing mastectomy for women who carry a pathogenic variant in PALB2 . Testing women at risk of hereditary breast cancer with a 7-gene panel was recently reported to be more cost-effective than testing only BRCA1/2 genes (Li et al . Value Health , 2017). Objectives : To evaluate the cost-effectiveness of a multigene panel testing strategy including 11 genes with risk reduction recommendations by the NCCN guidelines compared with testing only BRCA1/2 genes. Methods : Using a Markov model modified from the recent Li et al . publication, the 11-gene model was used to estimate life expectancies and total healthcare costs from a payers9 perspective. The model included costs for genetic testing, genetic consultation, and cancer treatment as well as risk reduction strategies recommended by the guidelines: prophylactic surgery, MRI surveillance, and mammography. Probabilistic sensitivity analyses were carried out to determine the robustness of the modeling. Results : In the base case, the incremental cost-effectiveness ratio (ICER) for the 11-gene multigene testing strategy compared with BRCA1/2 testing was $22,377 per life-year gained ($47,240 per quality-adjusted life-year gained) for a 40-year-old cohort and $36,690 per life-year gained ($63,384 per quality-adjusted life-year gained) for a 50-year-old cohort. The sensitivity analysis indicated that the multigene testing strategy had a 97% chance of costing less than $100,000 per quality-adjusted life-year gained for the 40-year-old cohort. Conclusion : In patients at risk of hereditary breast cancer, testing using a multigene panel followed by risk reducing interventions is cost-effective compared with testing only BRCA1/2 genes. Citation Format: Li Y, Arellano AR, Bare LA, Devlin JJ. Cost-effectiveness of genetic testing with a hereditary cancer panel in women at risk of hereditary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-02.