title: Estimating the survival benefits gained from providing national cancer genetic services to women with a family history of breast cancer.
abstract: The aim of this paper is to compare a service offering genetic testing and presymptomatic surveillance to women at increased risk of developing breast cancer with its predecessor of no service at all in terms of survival and quality-adjusted survival (QALYs) by means of a Markov cohort chain simulation model. Genetic assessment and presymptomatic care provided between 0.07-1.61 mean additional life years and 0.05-1.67 mean QALYs over no services. Prophylactic surgery and surveillance extended mean life expectancy by 0.41-1.61 and 0.32-0.99 years, respectively over no services for high-risk women. Model outcomes were sensitive to all the parameters varied in the sensitivity analysis. Providing cancer genetic services increase survival and as long as services do not induce adverse psychological effects they also provide more QALYs. The greatest survival and QALY benefits were found for women with identified mutations. As more cancer genes are identified, the survival and cost-effectiveness of genetic services will improve. Although mastectomy provided most additional life years, when quality of life was accounted for oophorectomy was the optimal strategy. Delayed entry into coordinated genetic services was found to diminish the average survival and QALY gains for a woman utilising these services.
authors.affiliation: Centre for the Economics of Health, Institute of Medical and Social Care Research, University of Wales, Bangor, Gwynedd LL57 2UW, UK. g.griffith@bangor.ac.uk
authors.forename: G L
authors.initials: GL
authors.lastname: Griffith
authors.forename: R T
authors.initials: RT
authors.lastname: Edwards
authors.forename: J
authors.initials: J
authors.lastname: Gray
authors.forename: C
authors.initials: C
authors.lastname: Wilkinson
authors.forename: J
authors.initials: J
authors.lastname: Turner
authors.forename: B
authors.initials: B
authors.lastname: France
authors.forename: P
authors.initials: P
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008390:Markov Chains; D008408:Mastectomy; D008875:Middle Aged; D008962:Models, Theoretical; D010052:Ovariectomy; D010375:Pedigree; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis