Table 2 Scenario analysis: perfect adherence to cancer risk management strategies.

Outcome	Familial cancer service: assuming perfect adherence	Incremental: perfect adherence/natural history	Incremental: perfect adherence/actual adherence rates
BRCA1
Undiscounted
Cost	$69,753	$4694	-$5610
Life-years	61.95	7.10	0.98
QALYs	52.39	6.32	0.93
ICER per LYG		$652	Dominant
ICER per QALY gained		$733	Dominant
Discounted 5%
Cost	$33,362	$20,839	$4398
Life-years	19.59	0.70	0.14
QALYs	16.76	0.66	0.15
ICER per LYG		$29,944	$32,793
ICER per QALY gained		$31,793	$30,247
BRCA2
Undiscounted
Cost	$59,652	$15,072	-$1790
Life-years	63.65	4.97	0.63
QALYs	53.94	4.46	0.61
ICER per LYG		$2661	Dominant
ICER per QALY gained		$2960	Dominant
Discounted 5%
Cost	$30,168	$23,395	$6473
Life-years	19.76	0.47	0.08
QALYs	16.93	0.44	0.09
ICER per LYG		$45,840	$80,963
ICER per QALY gained		$48,599	$69,708

Dominant refers to strategies that are both more effective and less costly than the comparator. Perfect adherence was defined as (1) all women not diagnosed with ovarian cancer have risk-reducing bilateral salpingo-oophorectomy by age 40 for BRCA1 and 45 for BRCA2; (2) all women not diagnosed with breast cancer undergo bilateral risk-reducing mastectomy by 30; (3) all women have a contralateral risk-reducing mastectomy in the year of their first breast cancer; (4) all women start breast magnetic resonance imaging at age 25, and mammogram at age 30; (5) all cancer-unaffected women attend the multidisciplinary high-risk clinic; (6) women attend breast imaging annually with no delay.
ICER incremental cost-effectiveness ratio, LYG life-year gained, QALY quality-adjusted life-year.

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