Which BRCA genetic testing programs are ready for implementation in health care? A systematic review of economic evaluations

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Which BRCA genetic testing programs are ready for implementation in health care? A systematic review of economic evaluations : Genetics in Medicine : Nature Publishing Group 
 
In conclusion, the results of this systematic review indicate that, although BRCA1/2 population-based screening is currently an inefficient use of health-care resources, population-based screening of the AJ (Ashkenazi Jews) community appears to be a good value for the money. Furthermore, it is highly likely that FH (family history)-based screening will prove cost-effective, although further economic evaluations that include the costs of identifying high-risk women are needed to fully justify this conclusion. This point is crucial because counseling strategies to detect at-risk individuals could involve primary-care physicians, and currently physicians seem to be not yet adequately prepared about hereditary breast cancer and BRCA1/2 testing.^47,48 Finally, in contrast to genetic testing for hereditary colorectal cancer (i.e., Lynch syndrome),^49,50,51 there is no evidence for the cost-effectiveness of screening for BRCA1/2 of newly diagnosed cases of breast and ovarian cancers, followed by cascade testing of relatives. However, cancer-based genetic screening programs for BRCA1/2 that includes tools for identifying women at higher risk for inherited forms are very promising in terms of cost-effectiveness. On the contrary, more high-quality studies are needed to prove the cost-effectiveness of BRCA genetic testing as an instrument of secondary prevention in affected women with predisposing gene mutation.
In any case, the price of BRCA1/2 testing is of paramount importance in determining the cost-effectiveness of BRCA1/2 testing programs.⁴⁴ If the cost of testing falls significantly, then all BRCA1/2 testing strategies analyzed in this review—perhaps including population-based screening—are likely to become highly cost-effective interventions.