In the Journals

Multigene testing for all patients with breast cancer cost-effective, ‘will save more lives’

Ranjit Manchanda, MD, PhD
Ranjit Manchanda

Multigene testing for all patients with breast cancer could be a cost-effective way to reduce disease burden compared with testing based upon family history or other clinical criteria, according to study results.

“Our research strategy is focused on targeted precision prevention, [and] a key theme in our research strategy for a long time has been broadening access to genetic testing. This will increase the number of people who can access prevention and screening and reduce burden of disease well beyond what is possible through current clinical protocols,” Ranjit Manchanda, MD, PhD, clinical senior lecturer at Wolfson Institute of Preventive Medicine of Barts Cancer Institute at Queen Mary University of London, told HemOnc Today. “This has two components and approaches — increasing testing at cancer diagnosis and population testing. The work for this particular paper is providing evidence for testing all [patients with] breast cancer.”

Manchanda and colleagues sought to compare two strategies for genetic testing among women with breast cancer in the United Kingdom and the United States, including lifetime costs, quality-adjusted life years (QALYs) and population effects. The first strategy involved multigene BRCA1/BRCA2/PALB2 testing; the second strategy consisted of the current practice of BRCA testing only for women who fulfill family-history based or clinical criteria.

Results showed that moving to a multigene testing strategy for all women with breast cancer, irrespective of family history or other criteria, could prevent 5,478 breast cancer cases and 4,255 ovarian cancer cases, as well as 2,406 breast and ovarian cancer deaths, annually in the United States. In the United Kingdom, such a strategy could prevent 2,101 breast or ovarian cancer cases and 633 deaths annually.

Multigene testing for all patients with breast cancer would carry an annual cost of $65,661 per QALY (£10,464/QALY in U.K.) from a payer perspective and $61,618 per QALY (£7,216/QALY in U.K.) from a societal perspective, compared with BRCA testing based on family history or clinical criteria. Those are significantly below the willingness-to-pay thresholds of $100,000/QALY in the U.S. and £30,000/QALY in the U.K.

The study’s modeling assumptions served as its primary limitation.

“Our findings support changing current policy to expand genetic testing to multigene testing for all women with breast cancer — this approach will save more lives and is cost-effective,” Manchanda said. “What is needed is development and evaluation of implementation models and pathways to deliver this. Implementation will need to be accompanied by a process of training and education for relevant clinicians and health professionals involved in the breast cancer care pathway, so that they can understand the implications for management.”

Decreasing costs of testing and technological advances offer huge new opportunities for cancer prevention and changes in the way cancer genetic testing is delivered in the health care setting, Manchanda added.

“This [multigene testing] approach can ensure that more women can take action to minimize their cancer risk through prevention or early diagnosis options,” he said. “We are now interested in evaluating and undertaking the analysis in other countries — including low- and middle-income countries — and also in the development and evaluation of context-specific implementation pathways for unselected testing at breast cancer diagnosis. We are working to raise funding for all of this.” – by Jennifer Southall

For more information:

Ranjit Manchanda, MD, PhD, can be reached at Queen Mary University of London, Room 4, Basement, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, United Kingdom; email: r.manchanda@qmul.ac.uk.

Disclosures: Manchanda reports receiving grants from Barts Charity, Cancer Research UK, the Eve Appeal and Rose Trees Trust outside the submitted work; honoraria for grant review from the Israel National Institute for Health Policy Research; and serving on advisory boards of AstraZeneca and Merck Sharp & Dohme. Please see the study for all other authors’ relevant financial disclosures.

Ranjit Manchanda, MD, PhD
Ranjit Manchanda

Multigene testing for all patients with breast cancer could be a cost-effective way to reduce disease burden compared with testing based upon family history or other clinical criteria, according to study results.

“Our research strategy is focused on targeted precision prevention, [and] a key theme in our research strategy for a long time has been broadening access to genetic testing. This will increase the number of people who can access prevention and screening and reduce burden of disease well beyond what is possible through current clinical protocols,” Ranjit Manchanda, MD, PhD, clinical senior lecturer at Wolfson Institute of Preventive Medicine of Barts Cancer Institute at Queen Mary University of London, told HemOnc Today. “This has two components and approaches — increasing testing at cancer diagnosis and population testing. The work for this particular paper is providing evidence for testing all [patients with] breast cancer.”

Manchanda and colleagues sought to compare two strategies for genetic testing among women with breast cancer in the United Kingdom and the United States, including lifetime costs, quality-adjusted life years (QALYs) and population effects. The first strategy involved multigene BRCA1/BRCA2/PALB2 testing; the second strategy consisted of the current practice of BRCA testing only for women who fulfill family-history based or clinical criteria.

Results showed that moving to a multigene testing strategy for all women with breast cancer, irrespective of family history or other criteria, could prevent 5,478 breast cancer cases and 4,255 ovarian cancer cases, as well as 2,406 breast and ovarian cancer deaths, annually in the United States. In the United Kingdom, such a strategy could prevent 2,101 breast or ovarian cancer cases and 633 deaths annually.

Multigene testing for all patients with breast cancer would carry an annual cost of $65,661 per QALY (£10,464/QALY in U.K.) from a payer perspective and $61,618 per QALY (£7,216/QALY in U.K.) from a societal perspective, compared with BRCA testing based on family history or clinical criteria. Those are significantly below the willingness-to-pay thresholds of $100,000/QALY in the U.S. and £30,000/QALY in the U.K.

The study’s modeling assumptions served as its primary limitation.

“Our findings support changing current policy to expand genetic testing to multigene testing for all women with breast cancer — this approach will save more lives and is cost-effective,” Manchanda said. “What is needed is development and evaluation of implementation models and pathways to deliver this. Implementation will need to be accompanied by a process of training and education for relevant clinicians and health professionals involved in the breast cancer care pathway, so that they can understand the implications for management.”

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Decreasing costs of testing and technological advances offer huge new opportunities for cancer prevention and changes in the way cancer genetic testing is delivered in the health care setting, Manchanda added.

“This [multigene testing] approach can ensure that more women can take action to minimize their cancer risk through prevention or early diagnosis options,” he said. “We are now interested in evaluating and undertaking the analysis in other countries — including low- and middle-income countries — and also in the development and evaluation of context-specific implementation pathways for unselected testing at breast cancer diagnosis. We are working to raise funding for all of this.” – by Jennifer Southall

For more information:

Ranjit Manchanda, MD, PhD, can be reached at Queen Mary University of London, Room 4, Basement, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, United Kingdom; email: r.manchanda@qmul.ac.uk.

Disclosures: Manchanda reports receiving grants from Barts Charity, Cancer Research UK, the Eve Appeal and Rose Trees Trust outside the submitted work; honoraria for grant review from the Israel National Institute for Health Policy Research; and serving on advisory boards of AstraZeneca and Merck Sharp & Dohme. Please see the study for all other authors’ relevant financial disclosures.