title: A cost analysis of a cancer genetic service model in the UK.
abstract: Technological advances in DNA sequencing have made gene testing fast and more affordable. Evidence of effectiveness and cost-effectiveness of genetic service models is essential for the successful translation of sequencing improvements for patient benefit, but remain sparse in the genetics literature. In particular, there is a lack of detailed cost data related to genetic services. A detailed micro-costing of 28 possible pathways relating to breast and/or ovarian cancer and BRCA testing was carried out by defining service activities and establishing associated costs. These data were combined with patient-level data from a Royal Marsden Cancer Genetics Service audit over a 6-month period during which BRCA testing was offered to individuals at ≥10 % risk of having a mutation, in line with current NICE guidance. The average cost across all patient pathways was £2227.39 (range £376.51 to £13,553.10). The average cost per pathway for an affected person was £1897.75 compared to £2410.53 for an unaffected person. Of the women seen in the Cancer Genetics Service during the audit, 38 % were affected with breast and/or ovarian cancer, and 62 % were unaffected but concerned about their family history. The most efficient service strategy is to identify unaffected relatives from an affected individual with an identified BRCA mutation. Implementation of this strategy would require more comprehensive testing of all eligible cancer patients, which could be achieved by integrating BRCA testing into oncology services. Such integration would be also more time-efficient and deliver greater equity of access to BRCA testing than the standard service model.
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK. ingrid@well.ox.ac.uk.|Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. ingrid@well.ox.ac.uk.|The Ethox Centre, University of Oxford, Oxford, UK. ingrid@well.ox.ac.uk.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Slade
authors.affiliation: The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.|Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Hanson
authors.affiliation: The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: George
authors.affiliation: Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kohut
authors.affiliation: The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.|TGLclinical, The Institute of Cancer Research, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Strydom
authors.affiliation: Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wordsworth
authors.affiliation: The Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.|Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, London, UK.|TGLclinical, The Institute of Cancer Research, London, UK.
authors.forename: Nazneen
authors.initials: N
authors.lastname: Rahman
keywords: BRCA; Breast cancer; Cancer genetics; Costs; Genetic services