Two additional topics are:
- Whether to extend BRCA genetic screening to women without a high-risk family history.
- Use and cost-effectiveness of gene panels (beyond BRCA) for a range of breast cancer risk genes.
The second topic is addressed in a new study.
In a study in Value in Health, Li, Devlin and colleagues report that gene panel screening is cost effectiven, with costs/QALY well in the $20,000-70,000 range used for other therapies. See Li et al. here. The costs/QALY for gene panels were also well in the range used for screening mammography (e.g. see Pataky et al., 2014, here). Coverage of Li et al. at Genomeweb, here.
Devil in the Details - Turning Devlin's Analysis Upside-Down
The authors state that they took costs for BRCA testing (and mammography) from the 2015 CMS fee schedules. The cost "for the seven gene test was provided by Quest diagnostics." The BRCA test was scored at $2178 ... and the cost of the seven gene panel as $2178 +$210 (see Devlin's Table 1, Costs [2015 US Dollars].
However, if you use 2017 Medicare fee schedules, Medicare prices BRCA panel testing at only $932, or alternately about $1400 in states that pay for extra dup-del coding (MolDX states block payment for extra dup-del coding).
Therefore, if you used actual Medicare panel pricing approaches, potentially the panel testing would be a savings of about $1200, literally the opposite direction than the add-on cost of +$210 over BRCA alone, carefully modeled by Li & Devlin.
Alternately, one could argue that open market available panel prices for breast cancer panels are advertised at $1500 or less, not at prices greater than $2100 for BRCA alone. I wrote a blog about this earlier this spring.
Alternately, one could argue that open market available panel prices for breast cancer panels are advertised at $1500 or less, not at prices greater than $2100 for BRCA alone. I wrote a blog about this earlier this spring.
