Table 1 Summary of key input parameters values and sources

From: Cost-effectiveness analysis of germ-line BRCA testing in women with breast cancer and cascade testing in family members of mutation carriers

Variable Base value SE/Range Distribution Source
Transition probabilities
 Starting age Affected=40 years 2.5 Normal Collins et al.21; Hayes et al.23
  Siblings=40 years 2.5 Normal  
  Children=10 years 2.0 Normal  
 Probability of BRCA mutation positive in affected individuals 15% 10–20% Uniform Konstantopoulou et al.9; Palma et al.4; Malone et al.6
 Probability to undergo RRM alone if positive 30% Dirichlet Collins et al.21
 Probability to undergo RRBSO only if BRCA-positive 54% Dirichlet Collins et al.21
 Probability to undergo RRM+RRBSO if BRCA-positive 16% - Dirichlet Collins et al.21
 Annual risk of contralateral breast cancer if BRCA-positive 20–29 years=0.000 0.010 Beta Mavaddat et al.3
  30–39 years=0.050 0.010 Beta  
  40–49 years=0.040 0.010 Beta  
  50–59 years=0.030 0.020 Beta  
  60–69 years=0.030 0.020 Beta  
 Annual risk of new incidence of breast cancer if BRCA-positive 20–29 years=0.005 0.001 Beta Mavaddat et al.3
  30–39 years=0.015 0.010 Beta  
  40–49 years=0.030 0.010 Beta  
  50–59 years=0.026 0.020 Beta  
  60–69 years=0.012 0.020 Beta  
 Annual risk of new incidence of ovarian cancer if BRCA-positive 20–29 years=0.000 0.020 Beta Mavaddat et al.3
  30–39 years=0.002 0.001 Beta  
  40–49 years=0.005 0.001 Beta  
  50–59 years=0.012 0.010 Beta  
  60–69 years=0.040 0.010 Beta  
  70–79 years=0.020 0.010 Beta  
 Population annual risk of breast cancer 20–29 years=0.000 0.001 Beta Australian Institute of Health and Welfare25
  30–39 years=0.001 0.001 Beta  
  40–49 years=0.002 0.001 Beta  
  50–59 years=0.003 0.002 Beta  
  60–69 years=0.003 0.002 Beta  
 Population annual risk of ovarian cancer 20–29 years=0.000 0.001 Beta Australian Institute of Health and Welfare26
  30–39 years=0.0000 0.0001 Beta  
  40–49 years=0.0001 0.0001 Beta  
  50–59 years=0.0002 0.0001 Beta  
  60–69 years=0.0003 0.0002 Beta  
  70–79 years=0.0004 0.0002 Beta  
 RR of ovarian cancer with RRBSO only 0.166 0.030 Log-normal Ludwig et al.10
 RR of breast cancer with RRBSO only 0.550 0.060 Log-normal Li et al.11
 RR of breast cancer with RRM only 0.110 0.030 Log-normal Li et al.11
 RR of ovarian and breast cancer with RRM+RRBSO 0.110 0.030 Log-normal Clinical expert advice
 Annual mortality of breast cancer 0.021 0.010 Beta Australian Institute of Health and Welfare25
 Annual mortality of ovarian cancer 0.15 0.060 Beta Australian Institute of Health and Welfare26
Utility values
 Utility for normal population 0.90 0.010 Beta Clemens et al.31
 Utility with breast cancer 0.79 0.100 Beta Peasgood et al.32; Manchanda et al.26
 Utility with ovarian cancer 0.63 0.250 Beta Manchanda et al.26
Costs in AU$
 Cost of BRCA test Gene sequencing=1,200 600 Gamma MBS item 73295
  Single-site=230 100 Gamma MBS item 73291
 Cost of genetic counseling 264 130 Gamma MBS item 132
 Cost of breast cancer treatment Year 1=24,510 12,000 Gamma Gamma MSAC application no 1098.1, February 2014
  Years 2–5=550 250   
 Cost of ovarian cancer treatment Year 1=20,000 10,000 Gamma Gamma Gordon 2010 35
  Years 2–5=5,000 2,500   
 Cost of RRBSO 8,621 400 Gamma Weighted value of AR-DRG N05A and N05B in Round 17 of National Hospital Cost Data Collection
 Cost of risk-reducing contralateral mastectomy 8,747 4,000 Gamma AR-DRG J06B in Round 17 of National Hospital Cost Data Collection
 Cost of risk-reducing bilateral mastectomy 15,586 7,000 Gamma AR-DRG J06B from Round 17 of National Hospital Cost Data Collection
  1. AR-DRG, Australian refined diagnosis-related group; AU$, Australian dollar; MBS, Medicare Benefits Schedule; MR, magnetic resonance imaging; MSAC, Medical Services Advisory Committee; RCPA, Royal College of Pathologists of Australia; RR, relative risk; RRBSO, risk-reducing salpingo-oophorectomy; RRM, risk-reducing mastectomy.