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To assess the cost effectiveness from a Canadian perspective of index patient germline BRCA testing and then, if positive, family members with subsequent risk-reducing surgery (RRS) in as yet unaffected mutation carriers compared with no testing and treatment of cancer when it develops.
Methods
A patient level simulation was developed comparing outcomes between two groups using Canadian data. Group 1: no mutation testing with treatment if cancer developed. Group 2: cascade testing (index patient BRCA tested and first-/second-degree relatives tested if index patient/first-degree relative is positive) with RRS in carriers. End points were the incremental cost-effectiveness ratio (ICER) and budget impact.
Results
There were 29,102 index patients: 2,786 ovarian cancer and 26,316 breast cancer (BC). Using the base-case assumption of 44 percent and 21 percent of women with a BRCA mutation receiving risk-reducing bilateral salpingo-oophorectomy and risk-reducing mastectomy, respectively, testing was cost effective versus no testing and treatment on cancer development, with an ICER of CAD 14,942 (USD 10,555) per quality-adjusted life-year (QALY), 127 and 104 fewer cases of ovarian and BC, respectively, and twenty-one fewer all-cause deaths. Testing remained cost effective versus no testing at the commonly accepted North American threshold of approximately CAD 100,000 (or USD 100,000) per QALY gained in all scenario analyses, and cost effectiveness improved as RRS uptake rates increased.
Conclusions
Prevention via testing and RRS is cost effective at current RRS uptake rates; however, optimization of uptake rates and RRS will increase cost effectiveness and can provide cost savings.
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University
The thirteenth century saw major developments in England's administration, as the procedures and processes of government expanded rapidly, the principles enshrined in Magna Carta became embedded, knights and burgesses were summoned to Parliament for the first time, and nothing short of a political revolution took place. The essays here draw on material available for the first time via the completion of the project to calendar all the Fine Rolls of Henry III; these rolls comprise the last series of records of the English Chancery from that period to become readily available in a convenient form, thereby transforming access to several important fields of research, including financial, legal, political and social issues. The volume covers topics including the evidential value of the fine rolls themselves and their wider significance for the English polity, developments in legal and financial administration, the roles of women and the church, and the fascinating details of the development of the office of escheator. Related or parallel developments in Scotland, Wales and Ireland are also dealt with, giving a broader British dimension.
Louise J. Wilkinson is Professor of Medieval History, Canterbury Christ Church University; David Crook is Honorary Research Fellow at the National Archives and the University of Notthingham.
Contributors: Nick Barratt, Paul Brand, David Carpenter, David Crook, Paul Dryburgh, Beth Hartland, Philippa Hoskin, Charles Insley, Adrian Jobson, Tony Moore, Alice Taylor, Nicholas Vincent, Scott Waugh, Louise Wilkinson
Edited by
David Crook, Former Assistant Keeper of Public Records, The National Archives (retired). Honorary Research Fellow in History at the University of Nottingham,Louise J. Wilkinson, Professor in Medieval History, Canterbury Christ Church University