Cost of high-risk surveillance for BRCA mutation carriers in Hong Kong

Abstract

Aim: BRCA mutation carriers have substantially higher risk for breast cancer development and thus intensive surveillance is indicated. This study aimed to describe the first medical cost analysis associated with the high-risk surveillance program in Hong Kong. Method: Healthcare perspective was adopted and thus only direct medical costs were described, referring to resources consumed as a result of surveillance. These included: diagnostic procedures, staging investigations, clinician consultations, interventions and hospitalization. Actual healthcare cost was estimated with rates from Hospital Authority and Department of Health. Results: Between January 2007 and December 2020 (14 years), 395 BRCA 1 and BRCA 2 mutation carriers were under high-risk surveillance with a median follow up of 3.7 years. Annual contrast MRI and annual mammogram with ultrasound breasts were performed alternately in a 6-month interval. Thirty-four cancers were detected out of 1997 screening sessions, with 88% in stage 0/1 and 94% node-negative. Twelve patients (34%) required chemotherapy. The cancer-detection rate was 20 per 1000 screen. The median number of screens to detect a cancer was 4 (1–17). The direct medical cost for surveillance per year per patient was 7890 HKD. The cost to detect one cancer was 269 480 HKD in the study period. Conclusion: High-risk surveillance is potentially cost-effective, in terms of detecting early cancer and reducing treatment cost. A cost-benefit analysis will be conducted subsequently to determine costs other than direct medical cost and patient's quality of life gained.