Cost Effectiveness of Whole Population BRCA Genetic Screening for Cancer Prevention in Israel.

With the growing technical ease and reduction in genetic screening costs, whole population screening may be a feasible option. Our objective was to investigate the cost effectiveness of whole population screening for mutations in Israel, for varying degrees of carrier state. Lifetime costs of whole female population screening for mutation carrier state versus nonscreening were compared using a Markovian process decision analysis model. Model parameters including ovarian and breast cancer risks were obtained from previously published data. Screening and other treatment-related costs were received from the Israeli Ministry of Health pricing list according to specified codes. Quality-adjusted life years were used for cost-effectiveness analysis. Sensitivity analysis was conducted to evaluate model uncertainties, specifically varying degrees of prevalence. Results show that whole population screening in Israel is cost effective across a wide range of prevalence rates with an incremental cost-effectiveness ratio of 81,493 new Israeli Shekels for a prevalence of 2.5%, increasing to 250,000 new Israeli Shekels for a 0.75% prevalence rate, per quality-adjusted life year gained. Discount rate and population prevalence and rate of risk reduction salpingo-oophorectomy are the most influential parameters in the model. Whole population screening for mutations should be offered as part of general health screening strategies by national medical insurance providers, even for non-Ashkenazi Jews. Our algorithm can be applied for other countries, adjusting local costs of screening and treatment. PREVENTION RELEVANCE: Whole population mutation screening in Israel is cost effective across a wide prevalence rate and should be offered as part of general health screening strategies by national medical insurance providers for cancer prevention.