title: Cost Comparison of Genetic Testing Strategies in Women With Epithelial Ovarian Cancer.
abstract: The advent of multigene panels has increased genetic testing options for women with epithelial ovarian cancer (EOC). We designed a decision model to compare costs and probabilities of identifying a deleterious mutation or variant of uncertain significance (VUS) using different genetic testing strategies.
  
  
  
  A decision model was developed to compare costs and outcomes of two testing strategies for women with EOC: multigene testing (MGT) versus single-gene testing for BRCA1/2. Outcomes were mean cost and number of deleterious mutations and VUSs identified. Model inputs were obtained from published genetic testing data in EOC. One-way sensitivity analyses and Monte Carlo probabilistic sensitivity analyses were performed.
  
  
  
  No family history model: MGT cost $1,160 more on average than BRCA1/2 testing and identified an additional 3.8 deleterious mutations for every 100 women tested. For each additional deleterious mutation identified, MGT cost $30,812 and identified 5.4 additional VUSs. Family history model: MGT cost $654 more on average and identified an additional 7.0 deleterious mutations for every 100 women tested. For each additional deleterious mutation identified, MGT cost $9,909 and identified 2.6 additional VUSs.
  
  
  
  MGT was associated with a higher additional cost per deleterious mutation identified and a higher ratio of VUS burden to actionable information in women with no family history as compared with women with a family history. Family history should be considered when determining an initial genetic testing platform in women with EOC.
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Foote
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Micael
authors.initials: M
authors.lastname: Lopez-Acevedo
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Buchanan
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Paula S
authors.initials: PS
authors.lastname: Lee
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fountain
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.affiliation: Duke University Medical Center, Durham, NC; and Ohio State University Medical Center, Columbus, OH.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005820:Genetic Testing / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008487:Medical History Taking; D018803:Models, Economic; D009154:Mutation; D009375:Neoplasms, Glandular and Epithelial / Q000191:economics / Q000235:genetics*; D010051:Ovarian Neoplasms / Q000191:economics / Q000235:genetics*
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human