Evidence map›Paper›PMID 41423596›Full record

Trial reportBMC primary care2025

Cost-effectiveness of primary care-based risk assessment and hereditary cancer genetic testing.

Beth Devine, Sanne E Aalbers, HuiHsuan Chan, Shangqing Jiang, Emerson J Dusic, Sarah Knerr, Heather M Harris, Catharine Wang, Barbara M Norquist, Laurie A Riemann and 3 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC primary care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04746794 (Implementing the Moon), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04746794 nacompletednot on this map

Implementing the Moon: Getting Genomic Testing to the Public

TypeinterventionalSponsorUniversity of WashingtonRan2020 to 2023Enrolled20,184ConditionsGenetic PredispositionArmsPopulation-level screening
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Beth DevineThe Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. bdevine@uw.edu.
Sanne E AalbersUniversity of Maryland College Park, 7600 Baltimore Ave, College Park, MD, 20740, USA.
HuiHsuan ChanThe Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Shangqing JiangThe Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
Emerson J DusicSchool of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 , USA.
Sarah KnerrSchool of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Heather M HarrisSchool of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 , USA.
Catharine WangSchool of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Barbara M NorquistSchool of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 , USA.
Laurie A RiemannBillings Clinic, 801 North 29th Street, PO Box 35100, Billings, MT 59107, USA.
Jeannine M BrantCity of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
Brian H ShirtsSchool of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 , USA.
Elizabeth M SwisherSchool of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195 , USA.

Funding

Implementing the moon: Getting genomic testing to the publicU01CA232795 · NCI · UNIVERSITY OF WASHINGTON · PI SWISHER, ELIZABETH MARY · 2019 to 2020
$5.8M
National Cancer Institute, NIH U01CA232795NCI NIH HHS U01 CA232795NIH National Institute of Health & NCI National Cancer Institute UL1-TR002319NIH National Institutes of Health & (NCATS) National Center for Advancing Translation Sciences TL1-TR002318NIH National Institutes of Health & NCI National Cancer Institute KL2-TR002317
6 · The paper itself

Abstract

backgroundGuidelines recommend identifying individuals with a family or personal history of cancer, offering genetic testing, with the goal of managing disease risk. Yet, risk assessment (“screening”) and genetic testing remain underutilized in the primary care setting and the value of an optimal strategy for engaging individuals is unknown. Our goal is to estimate the incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) between two population-based engagement strategies in proportions of individuals risk assessed and tested, by providing these services in a primary care setting.

methodsData were obtained from the EDGE (Early Detection of GEnetic risk)-clinic-randomized controlled trial that evaluated two engagement strategies - an in-clinic point of care (POC) strategy and a direct participant engagement (DPE) strategy that involved (e)mailing invitations after a visit. At risk participants were offered complementary genetic testing and counseling. Using these data, we constructed a decision-analytic cohort model and compared the POC to DPE strategy. We modeled testing all clinic participants over a two-year timeframe and present results from both health-system and limited societal perspectives. Outcomes were the proportion of participants risk-assessed and tested, the costs for each strategy, and the ICERs.

resultsFrom the health-system perspective, costs for approaching 100,000 participants were $641,278 (POC) and $702,653 (DPE). The POC strategy led to 14,490 (46%) of participants completing risk assessment and the DPE strategy to 6,385 (7%) participants, thus POC dominated DPE for risk assessment completion (68% of simulations). The POC strategy led to fewer individuals completing testing than the DPE strategy [780 (73%) vs. 1,184 (77%)], revealing an ICER of $152 (health-system) and $136 (limited societal) perspectives in favor of DPE (52% and 58% of simulations). With substantial uncertainty, results suggest that the DPE strategy may provide good value for money spent on testing at a willingness-to-pay test-kit cost of $250. CONCLUSIONS AND RELEVANCE: That the incremental cost-effectiveness of risk assessment versus testing contrasts, suggests that engagement approaches play an important role in shaping outcomes of population-based risk assessments. A hybrid approach (DPE, followed by POC for those who do not respond) may be optimally cost-effective.

trial registrationNCT04746794; Date: February 4, 2021.

Indexed as

Early Detection of CancerGenetic TestingNeoplasmsPrimary Health CareCost-Benefit AnalysisCost-Effectiveness AnalysisFemaleHumansMaleMiddle AgedQuality-Adjusted Life YearsRisk AssessmentCost-effectivenessDecision modelingGenetic testingHereditary cancer risk assessment/ScreeningPragmatic clinical trialPrimary care

Identifiers

PMID41423596
PMCPMC12859946

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.