Table 9 Total cost per event pathway

From: A micro costing of NHS cancer genetic services

    

Sensitivity

Event pathway

Counselling and administrative costs (min–max)

Laboratory costs

Total cost (min–max)

25% of time on indirect work (min–max)

75% of time on indirect work (min–max)

1. Family history questionnaire not returned

£16 (£14–£17)

£0.00

£16 (£14–£17)

£13 (£12)

£41 (£36–£47)

2. Inappropriate referral

£98 (£51–£144)

£0.00

£98 (£51–£144)

£85 (£44–£125)

£260 (£137–£384)

3. Moderate risk – breast cancer

£97 (£40–£153)

£0.00

£97 (£40–£153)

£84 (£35–£133)

£258 (£107–£408)

4. Moderate risk – colorectal cancer

£98 (£51–£144)

£0.00

£98 (£51–£144)

£85 (£44–£125

£260 (£137–£384)

5. Moderate Risk – ovarian or breast ovarian cancera

£151 (£79–£223)

£0.00

£151 (£79–£223)

£131 (£69–£194)

£400 (£208–£592)

High risk – colorectal (HNPCC)

     

6. Test cancer-affected relative (mutation found) and test presymptomatic patientb

£1396 (£803–£1988)

£1676

£3072 (£2479–£3664)

£2887.79 (£2,373.76–£3401.82)

£5371.49 (£3799.73–£6943.25)

7. Test cancer-affected relative (no mutation found) and do not test presymptomatic patientb

£826 (£466–£1186)

£1213

£2039 (£1678–£2399)

£1929.86 (£1617.39–£2242.32)

£3397.61 (£2442.01–£4353.24)

8. Test subsequent presymptomatic members of a family with an established mutation (MLH1/ MSH2 mutation in family)

£997 (£579–£1415)

£464

£1461 (£1043–£1879)

£1329.32 (£966.80–£1691.86)

£3104.66 (£1996.40–£4212.92)

9. Counsel and arrange presymptomatic care for members of a family with no established mutation

£975 (£557–£1392)

£0.00

£975 (£557–£1392)

£846 (£484–£1208)

£2581 (£1475–£3688)

High risk – colorectal (FAP)

     

10. Test cancer-affected relative (mutation found) and test presymptomatic patientb

£1396 (£803–£1988)

£1292

£2687 (£2095–£3280)

£2503 (£1989–£3017)

£4987 (£3415–£6559)

11. Test cancer-affected relative (no mutation found) and do not test presymptomatic patientb

£826 (£466–£1186)

£842

£1668 (£1307–£2028)

£1558.88 (£1246.41–£1871.34)

£3026.63 (£2071.03–£3982.26)

12. Test subsequent presymptomatic members of a family with an established mutation (using linkage testing)

£997 (£579–£1415)

£592

£1589 (£1171–£2007)

£1458 (£1095–£1820)

£3233 (£2125–£4341)

13. Test subsequent presymptomatic members of a family with an established mutation (using sequence analysis)

£997 (£579–£1415)

£450

£1447 (£1029–£1865)

£1316 (£953–£1678)

£3091 (£1983–£4199)

14. Counsel and arrange presymptomatic care for members of a family with no established mutation

£975 (£557–£1392)

£0.00

£975 (£557–£1392)

£846 (£484–£1208)

£2,581 (Ł1475–£3688)

High risk – breast (BRCA1/2)

     

15. Test cancer-affected relative (mutation found) and test presymptomatic patientb

£996 (£437–£1555)

£1514

£2510 (£1950–£3069)

£2379 (£1894–£2864)

£4143 (£2660–£5626)

16. Test cancer-affected relative (no mutation found) and do not test presymptomatic patientb

£614 (£283–£946)

£1050

£1665 (£1333–£1996)

£1584 (£1296–£1872)

£2671 (£1791–£3551)

17. Test subsequent presymptomatic members of a family with an established mutation

£688 (£288–£1087)

£464

£1152 (£752–£1551)

£1061 (£715–£1408)

£2280 (£1221–£3340)

18. Counsel and arrange presymptomatic care for members of a family with no established mutation

£675 (£279–£1070)

£0.00

£675 (£279–£1070)

£586 (£243–£929)

£1782 (£733–£2831)

High risk – ovarian or breast ovarian (BRCA1/2)c

     

19. Test cancer-affected relative (mutation found) and test presymptomatic patientb

£1396 (£803–£1988)

£1514

£2909 (£2317–£3502)

£2725 (£2211–£3240)

£5209 (£3637–£6781)

20. Test cancer-affected relative (no mutation found) and do not test presymptomatic patientb

£826 (£466–£1186)

£1050

£1876 (£1516–£2236)

£1768 (£1455–£2080)

£3235 (£2280–£4191)

21. Test subsequent presymptomatic members of a family with an established mutation

£997 (£579–£1415)

£464

£1461 (£1043–£1879)

£1329 (£967–£1692)

£3105 (£1996–£4213)

22. Counsel and arrange presymptomatic care for members of a family with no established mutation

£975 (£557–£1392)

£0.00

£975 (£557–£1392)

£846 (£484–£1208)

£2581 (£1475–£3688)

  1. Costs are rounded to the nearest £1 within each column. HNPCC=hereditary nonpolyposis colorectal cancer; FAP or FAPC=familial adenomatous polyposis coli.
  2. aJoint ovarian clinic for moderate risk ovarian/breast ovarian: min =£27.26, max =£51.44, mean = £39.35.
  3. bIf the cancer-affected relative of a high-risk patient is too ill to attend the cancer genetics clinic, a genetic counsellor will make a home visit. A home visit would result in a mean net increase of £36.60 to the cost of testing a cancer-affected relative and the presymptomatic patient.
  4. cJoint ovarian clinic for high-risk ovarian/breast ovarian: min =£36.75, max =£110.25, mean = £73.50.
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