Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China
BackgroundThe women’s cancer screening program has been operational for several years in China, primarily utilizing palpation and ultrasound. Given the proven impact of BRCA1/2 mutations on the incidence of breast and ovarian cancer, the cost-effectiveness of incorporating BRCA1/2 mutation testing i...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1479966/full |
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| author | Feilong Zhao Shu Wang Shu Wang Jianfei Lu Xiangying Feng Liwei Ran Jianjun Yang Jianjun Yang |
| author_facet | Feilong Zhao Shu Wang Shu Wang Jianfei Lu Xiangying Feng Liwei Ran Jianjun Yang Jianjun Yang |
| author_sort | Feilong Zhao |
| collection | DOAJ |
| description | BackgroundThe women’s cancer screening program has been operational for several years in China, primarily utilizing palpation and ultrasound. Given the proven impact of BRCA1/2 mutations on the incidence of breast and ovarian cancer, the cost-effectiveness of incorporating BRCA1/2 mutation testing into these programs, either for the entire population or through enrichment based on family history of breast and ovarian cancer, remains poorly researched.MethodsWe constructed a decision tree model to compare the cost-effectiveness of three strategies: symptom-based screening only (Symptom-only strategy), population-based BRCA1/2 testing (population-based strategy), and family-history-based BRCA1/2 testing (FH-based strategy). One-way and probability sensitivity analyses enabled model uncertainty evaluation. Outcomes included early and advanced stages of ovarian and breast cancer. Cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. The target population was women at 40–60 years, the time horizon was until age 70, and the perspective was payer-based.ResultsThe FH-based strategy was found to be cost-effective compared to the Symptom-only strategy (ICER: ¥185,710/QALY, gaining 0.26 days’ life expectancy). Its cost-effectiveness was significantly influenced by the risks of ovarian and breast cancer among BRCA1/2 carriers, the prevalence of BRCA1/2 mutations in the general Chinese population, the prevalence of family history of breast and ovarian cancer among Chinese women, and the prevalence of BRCA1/2 mutations in the FH-positive population. Integrating these variable distributions, the FH-based strategy showed a 76.96% probability of cost-effectiveness. The Population-based strategy was not cost-effective, whether compared to the Symptom-only strategy (ICER: ¥504,476/QALY, gaining 2.66 days’ life expectancy) or to the FH-based strategy (ICER: ¥539,476/QALY, gaining 2.41 days’ life expectancy). The prevalence of BRCA1/2 mutations in the general Chinese population was identified as the primary variable affecting its cost-effectiveness. Integrating these variable distributions, the Population-based strategy had a probability of cost-effectiveness of only 0.8%.ConclusionIncorporating family-history-based BRCA1/2 testing into breast and ovarian cancer screening programs is cost-effective in China and warrants promotion. |
| format | Article |
| id | doaj-art-ba57db0970854193a35f8ea547d11b97 |
| institution | OA Journals |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Public Health |
| spelling | doaj-art-ba57db0970854193a35f8ea547d11b972025-08-20T02:34:10ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-06-011310.3389/fpubh.2025.14799661479966Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in ChinaFeilong Zhao0Shu Wang1Shu Wang2Jianfei Lu3Xiangying Feng4Liwei Ran5Jianjun Yang6Jianjun Yang7Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaState Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaInstitute for Hospital Management of Tsinghua University, Shenzhen, ChinaDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaDepartment of Dermatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, ChinaDepartment of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaState Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, ChinaBackgroundThe women’s cancer screening program has been operational for several years in China, primarily utilizing palpation and ultrasound. Given the proven impact of BRCA1/2 mutations on the incidence of breast and ovarian cancer, the cost-effectiveness of incorporating BRCA1/2 mutation testing into these programs, either for the entire population or through enrichment based on family history of breast and ovarian cancer, remains poorly researched.MethodsWe constructed a decision tree model to compare the cost-effectiveness of three strategies: symptom-based screening only (Symptom-only strategy), population-based BRCA1/2 testing (population-based strategy), and family-history-based BRCA1/2 testing (FH-based strategy). One-way and probability sensitivity analyses enabled model uncertainty evaluation. Outcomes included early and advanced stages of ovarian and breast cancer. Cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. The target population was women at 40–60 years, the time horizon was until age 70, and the perspective was payer-based.ResultsThe FH-based strategy was found to be cost-effective compared to the Symptom-only strategy (ICER: ¥185,710/QALY, gaining 0.26 days’ life expectancy). Its cost-effectiveness was significantly influenced by the risks of ovarian and breast cancer among BRCA1/2 carriers, the prevalence of BRCA1/2 mutations in the general Chinese population, the prevalence of family history of breast and ovarian cancer among Chinese women, and the prevalence of BRCA1/2 mutations in the FH-positive population. Integrating these variable distributions, the FH-based strategy showed a 76.96% probability of cost-effectiveness. The Population-based strategy was not cost-effective, whether compared to the Symptom-only strategy (ICER: ¥504,476/QALY, gaining 2.66 days’ life expectancy) or to the FH-based strategy (ICER: ¥539,476/QALY, gaining 2.41 days’ life expectancy). The prevalence of BRCA1/2 mutations in the general Chinese population was identified as the primary variable affecting its cost-effectiveness. Integrating these variable distributions, the Population-based strategy had a probability of cost-effectiveness of only 0.8%.ConclusionIncorporating family-history-based BRCA1/2 testing into breast and ovarian cancer screening programs is cost-effective in China and warrants promotion.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1479966/fullBRCA1BRCA2ovarian cancerbreast cancerfamily historyChina |
| spellingShingle | Feilong Zhao Shu Wang Shu Wang Jianfei Lu Xiangying Feng Liwei Ran Jianjun Yang Jianjun Yang Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China Frontiers in Public Health BRCA1 BRCA2 ovarian cancer breast cancer family history China |
| title | Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China |
| title_full | Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China |
| title_fullStr | Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China |
| title_full_unstemmed | Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China |
| title_short | Cost-effectiveness analysis of population-based BRCA1/2 testing, family-history-based BRCA1/2 testing, and symptom-based screening for breast and ovarian cancer in China |
| title_sort | cost effectiveness analysis of population based brca1 2 testing family history based brca1 2 testing and symptom based screening for breast and ovarian cancer in china |
| topic | BRCA1 BRCA2 ovarian cancer breast cancer family history China |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1479966/full |
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