title: Economic Evaluation Alongside a Clinical Trial of Telephone Versus In-Person Genetic Counseling for BRCA1/2 Mutations in Geographically Underserved Areas.
abstract: OBJECTIVE
  BRCA1/2 counseling and mutation testing is recommended for high-risk women, but geographic barriers exist, and no data on the costs and yields of diverse delivery approaches are available.
  
  
  METHODS
  We performed an economic evaluation with a randomized clinical trial comparing telephone versus in-person counseling at 14 locations (nine geographically remote). Costs included fixed overhead, variable staff, and patient time costs; research costs were excluded. Outcomes included average per-person costs for pretest counseling; mutations detected; and overall counseling, testing, and disclosure. Sensitivity analyses were performed to assess the impact of uncertainty.
  
  
  RESULTS
  In-person counseling was more costly per person counseled than was telephone counseling ($270 [range, $180 to $400] v $120 [range, $80 to $200], respectively). Counselors averaged 285 miles round-trip to deliver in-person counseling to the participants (three participants per session). There were no differences by arm in mutation detection rates (approximately 10%); therefore, telephone counseling was less costly per positive mutation detected than was in-person counseling ($37,160 [range, $36,080 to$38,920] v $40,330 [range, $38,010 to $43,870]). In-person counseling would only be less costly than telephone counseling if the most favorable assumptions were applied to in personc ounseling and the least favorable assumptions were applied to telephone counseling.
  
  
  CONCLUSIONS
  In geographically underserved areas, telephone counseling is less costly than in-person counseling.
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Yaojen
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Near
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Butler
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hoeffken
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Edwards
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kohlmann
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gammon
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Saundra S
authors.initials: SS
authors.lastname: Buys
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Beth N
authors.initials: BN
authors.lastname: Peshkin
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT mandelbj@georgetown.edu.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Yaojen
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Near
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Butler
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hoeffken
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Edwards
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Stroup
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Wendy
authors.initials: W
authors.lastname: Kohlmann
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gammon
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Saundra S
authors.initials: SS
authors.lastname: Buys
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Beth N
authors.initials: BN
authors.lastname: Peshkin
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Kinney
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC; University of New Mexico Cancer Center, Albuquerque, NM; and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT mandelbj@georgetown.edu.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000379:methods; D005820:Genetic Testing / Q000191:economics; D006801:Humans; D008507:Medically Underserved Area; D008875:Middle Aged; D009154:Mutation; D017063:Outcome Assessment, Health Care; D012042:Registries; D019035:Rural Health Services; D057566:Self Report; D012959:Socioeconomic Factors; D013689:Telephone; D014589:Utah