Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, 13833-19967, Tehran, Iran.
BMC Cancer. 2024 Mar 1;24(1):279. doi: 10.1186/s12885-024-12003-4.
This study aimed to evaluate the implementation of the population- and family history (FH) -based screening for BReast CAncer (BRCA) in Iran, a country where less than 10% of breast cancer cases are attributable to a gene mutation.
This was an economic evaluation study. The Benefit-Cost Ratio (BCR) for genetic screening test strategies in Iranian women older than 30 was calculated. To this end, the monetary value of the test was estimated using the willingness-to-pay (WTP) approach using the contingent valuation method (CVM) by payment card. From a healthcare perspective, direct medical and non-medical costs were considered and a decision model for the strategies was developed to simulate the costs. A one-way sensitivity analysis assessed the robustness of the analysis. The data were analyzed using Excel 2010.
660 women were included for estimating WTP and 2,176,919 women were considered in the costing model. The cost per genetic screening test for population- and FH-based strategies was $167 and $8, respectively. The monetary value of a genetic screening test was $20 and it was $27 for women with a family history or gene mutation in breast cancer. The BCR for population-based and FH-based screening strategies was 0.12 and 3.37, respectively. Sensitivity analyses confirmed the robustness of the results.
This study recommends the implementation of a FH-based strategy instead of a population-based genetic screening strategy in Iran, although a cascade genetic screening test strategy should be evaluated in future studies.
本研究旨在评估伊朗基于人群和家族史（FH）的乳腺癌（BRCA）筛查的实施情况，该国不到 10%的乳腺癌病例归因于基因突变。
这是一项经济评估研究。计算了 30 岁以上伊朗女性基因筛查测试策略的收益成本比（BCR）。为此，使用意愿支付（WTP）方法通过支付卡使用条件价值评估法（CVM）估算了测试的货币价值。从医疗保健的角度来看，考虑了直接医疗和非医疗成本，并为策略开发了决策模型以模拟成本。单向敏感性分析评估了分析的稳健性。使用 Excel 2010 分析数据。
纳入了 660 名女性来估算 WTP，考虑了 2176919 名女性的成本模型。基于人群和 FH 的策略的基因筛查测试的成本分别为 167 美元和 8 美元。基因筛查测试的货币价值为 20 美元，具有乳腺癌家族史或基因突变的女性为 27 美元。基于人群和 FH 的筛查策略的 BCR 分别为 0.12 和 3.37。敏感性分析证实了结果的稳健性。
本研究建议在伊朗实施基于 FH 的策略，而不是基于人群的遗传筛查策略，尽管未来的研究应评估级联遗传筛查测试策略。
