Table 3.

Health and economic outcomes of 100,000 simulated individuals in the general population plus first-degree relatives of mutation carriers exposed to primary genetic screening strategies

Screening strategyNumber of 4-gene tests offered per 100,000 simulated individuals in the general populationNumber of first-degree relatives tested per 100,000 simulated individuals in the general populationAverage number of 4-gene tests needed to identify an additional mutation carrierQALYs gained per 100,000 simulated individuals in the general population relative to current practiceIncrease in cost relative to current practice ($ million)Average cost-effectiveness ratio ($/QALY)Incremental cost-effectiveness ratio ($/QALY)
StrategyScreening start-age (y)Risk threshold (%)
1200.0100,000885140.4933374.2401,0197,008,872
2250.099,999837141.0925318.1343,870490,315
3300.099,997821141.3800268.7335,900-
4350.099,352790143.8675227.0336,253-
5400.098,566754144.0546193.9355,191-
6202.56,15949916.831318.659,357-
7252.56,09546517.131117.054,74892,555
8302.56,00344417.328814.951,774-
9352.55,99543617.226612.948,35274,023
10402.55,98442217.222011.853,770-
11205.01,5463497.291514.731,241-
12255.01,5113187.311474.127,57144,537
13305.01,4752987.411353.526,229-
14355.01,4592877.511253.124,58540,645
15405.01,4192717.61022.726,662-
162010.02872532.63690.913,300-
172510.02692252.60670.710,68237,268
183010.02592052.56630.68,99414,922
193510.02521902.55560.58,25310,331
204010.02471732.56450.37,7457,745

NOTE: Average cost-effectiveness ratio is relative to current practice. Incremental cost-effectiveness ratio is relative to the adjacent screening strategy on the efficient frontier (Fig. 1A). Dashes (-) in the table represent dominated strategies (those below the efficient frontier).