478 lines
No EOL
91 KiB
HTML
478 lines
No EOL
91 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
|
|
|
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
|
<!-- AppResources meta begin -->
|
|
<meta name="paf-app-resources" content="" />
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- AppResources meta end -->
|
|
|
|
<!-- TemplateResources meta begin -->
|
|
<meta name="paf_template" content="" />
|
|
|
|
<!-- TemplateResources meta end -->
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK65446" /><meta name="ncbi_domain" content="nicecg14" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK65446/" /><meta name="ncbi_pagename" content="Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2 - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="appendix" /><meta name="ncbi_app" content="bookshelf" />
|
|
<!-- Logger end -->
|
|
|
|
<title>Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2 - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care - NCBI Bookshelf</title>
|
|
|
|
<!-- AppResources external_resources begin -->
|
|
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
|
|
|
<!-- AppResources external_resources end -->
|
|
|
|
<!-- Page meta begin -->
|
|
<meta name="robots" content="NOINDEX,NOFOLLOW,NOARCHIVE,NOIMAGEINDEX" /><meta name="citation_inbook_title" content="Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet]" /><meta name="citation_title" content="Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2" /><meta name="citation_publisher" content="University of Sheffield" /><meta name="citation_date" content="2004/05" /><meta name="citation_author" content="School of Health and Related Research (ScHARR), University of Sheffield" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65446/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="University of Sheffield" /><meta name="DC.Contributor" content="School of Health and Related Research (ScHARR), University of Sheffield" /><meta name="DC.Date" content="2004/05" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65446/" /><meta name="DC.Language" content="en" /><meta name="description" content="The following model was built to provide an insight into the cost-effectiveness of genetic testing for BRCA1/2 breast/ovarian cancer mutations in a UK setting. The model was made available to the GDG but was not discussed by the group or used to determine guideline recommendations. It must be stressed that the modelling presented here is a preliminary piece of work which is intended to highlight the important uncertainties that exist in this area but is not sufficiently well developed to be used for decision making." /><meta name="og:title" content="Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2" /><meta name="og:type" content="book" /><meta name="og:description" content="The following model was built to provide an insight into the cost-effectiveness of genetic testing for BRCA1/2 breast/ovarian cancer mutations in a UK setting. The model was made available to the GDG but was not discussed by the group or used to determine guideline recommendations. It must be stressed that the modelling presented here is a preliminary piece of work which is intended to highlight the important uncertainties that exist in this area but is not sufficiently well developed to be used for decision making." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65446/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg14-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="warning" content="This publication is provided for historical reference only and the information may be out of date." /><meta name="bk-non-canon-loc" content="/books/n/nicecg14/appendixes.app20/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65446/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">.main-content {background:transparent repeat-y top left;background-image:url(/corehtml/pmc/css/bookshelf/2.26/img/archive.png);background-size: auto, contain; padding:0 0 0 3em }</style><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="nicecollect" />
|
|
|
|
<!-- Page meta end -->
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8E95DE7D7A00A100000000007B0061.m_13" />
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
|
<body class="book-part">
|
|
<div class="grid">
|
|
<div class="col twelve_col nomargin shadow">
|
|
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
|
<div class="sysmessages">
|
|
<noscript>
|
|
<p class="nojs">
|
|
<strong>Warning:</strong>
|
|
The NCBI web site requires JavaScript to function.
|
|
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
|
</p>
|
|
</noscript>
|
|
</div>
|
|
<!--/.sysmessage-->
|
|
<div class="wrap">
|
|
<div class="page">
|
|
<div class="top">
|
|
<div id="universal_header">
|
|
<section class="usa-banner">
|
|
<div class="usa-accordion">
|
|
<header class="usa-banner-header">
|
|
<div class="usa-grid usa-banner-inner">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
|
<p>An official website of the United States government</p>
|
|
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
|
<span class="usa-banner-button-text">Here's how you know</span>
|
|
</button>
|
|
</div>
|
|
</header>
|
|
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
|
<div class="usa-banner-guidance-gov usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The .gov means it's official.</strong>
|
|
<br />
|
|
Federal government websites often end in .gov or .mil. Before
|
|
sharing sensitive information, make sure you're on a federal
|
|
government site.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The site is secure.</strong>
|
|
<br />
|
|
The <strong>https://</strong> ensures that you are connecting to the
|
|
official website and that any information you provide is encrypted
|
|
and transmitted securely.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<div class="usa-overlay"></div>
|
|
<header class="ncbi-header" role="banner" data-section="Header">
|
|
|
|
<div class="usa-grid">
|
|
<div class="usa-width-one-whole">
|
|
|
|
<div class="ncbi-header__logo">
|
|
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ncbi-header__account">
|
|
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
|
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
|
<span class="fa fa-user" aria-hidden="true">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
|
<g style="fill: #fff">
|
|
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
|
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
|
</g>
|
|
</svg>
|
|
</span>
|
|
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
|
<span class="sr-only">Show account info</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="ncbi-popup-anchor">
|
|
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
|
<div class="ncbi-popup-head">
|
|
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
|
<span class="fa fa-times">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
|
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
|
</svg>
|
|
</span>
|
|
<span class="usa-sr-only">Close</span></button>
|
|
<h4>Account</h4>
|
|
</div>
|
|
<div class="account-user-info">
|
|
Logged in as:<br />
|
|
<b><span class="username" id="uname_long">username</span></b>
|
|
</div>
|
|
<div class="account-links">
|
|
<ul class="usa-unstyled-list">
|
|
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
|
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
|
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
|
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
|
</ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</header>
|
|
<div role="navigation" aria-label="access keys">
|
|
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
|
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
|
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
|
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
|
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
|
</div>
|
|
<section data-section="Alerts">
|
|
<div class="ncbi-alerts-placeholder"></div>
|
|
</section>
|
|
</div>
|
|
<div class="header">
|
|
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
|
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="pubmed">PubMed</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore" class="last">Nucleotide</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
|
<a href="/books/browse/">Browse Titles</a>
|
|
</li><li>
|
|
<a href="/books/advanced/">Advanced</a>
|
|
</li><li class="help">
|
|
<a href="/books/NBK3833/">Help</a>
|
|
</li><li class="disclaimer">
|
|
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
|
</li></ul></div>
|
|
</div>
|
|
|
|
|
|
|
|
<!--<component id="Page" label="headcontent"/>-->
|
|
|
|
</div>
|
|
<div class="content">
|
|
<!-- site messages -->
|
|
<!-- Custom content 1 -->
|
|
<div class="col1">
|
|
|
|
</div>
|
|
|
|
<div class="container">
|
|
<div id="maincontent" class="content eight_col col">
|
|
<!-- Custom content in the left column above book nav -->
|
|
<div class="col2">
|
|
|
|
</div>
|
|
|
|
<!-- Book content -->
|
|
|
|
|
|
<!-- Custom content between navigation and content -->
|
|
<div class="col3">
|
|
|
|
</div>
|
|
|
|
<div class="document">
|
|
<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet]. Sheffield (UK): University of Sheffield; 2004 May. (NICE Clinical Guidelines, No. 14.)</p></div><div class="bk_msg_box bk_bttm_mrgn clearfix bk_noprnt"><div class="iconblock clearfix"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg164guid/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg164guid-lrg.png" alt="Cover" height="100px" width="80px" /></a><div class="icnblk_cntnt"><ul class="messages"><li class="info icon"><span class="icon"><a href="/books/n/nicecg164guid/">A new version of this title is available</a></span></li></ul></div></div></div><div class="messagearea bk_noprnt" style="margin-bottom:1.3846em "><ul class="messages"><li class="warn icon"><span class="icon">This publication is provided for historical reference only and the information may be out of date.</span></li></ul></div><div class="bk_prnt"><p style="color:red;"><strong>This publication is provided for historical reference only and the information may be out of date.</strong></p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg14/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg14-lrg.png" alt="Cover of Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65446_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65446_dtls__"><div>NICE Clinical Guidelines, No. 14.</div><div>School of Health and Related Research (ScHARR), University of Sheffield.</div><div>Sheffield (UK): <a href="https://www.sheffield.ac.uk/scharr" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">University of Sheffield</a>; 2004 May.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/nicecg14/">Contents</a></li></ul></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg14/appendixes.app19/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg14/appendixes.app21/" title="Next page in this title">Next ></a></div></div></div></div></div>
|
|
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65446_"><span class="label">Appendix 20</span><span class="title" itemprop="name">Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2</span></h1></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="appendixes.app20.s1"><h2 id="_appendixes_app20_s1_">Background</h2><p>The following model was built to provide an insight into the cost-effectiveness of genetic testing for BRCA1/2 breast/ovarian cancer mutations in a UK setting. The model was made available to the GDG but was not discussed by the group or used to determine guideline recommendations. It must be stressed that the modelling presented here is a preliminary piece of work which is intended to highlight the important uncertainties that exist in this area but is not sufficiently well developed to be used for decision making.</p></div><div id="appendixes.app20.s2"><h2 id="_appendixes_app20_s2_">Overview of model</h2><p>The analysis compares a full <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">gene</a> genetic test to no testing for women at high <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> of developing breast cancer due to familial history using a Markov decision tree model developed in DATA Professional<sup><a class="bk_pop" href="#appendixes.app20.fn1">1</a></sup>. An overview of the model structure is shown in <a class="figpopup" href="/books/NBK65446/figure/appendixes.app20.f1/?report=objectonly" target="object" rid-figpopup="figappendixesapp20f1" rid-ob="figobappendixesapp20f1">figure 1</a>.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figappendixesapp20f1" co-legend-rid="figlgndappendixesapp20f1"><a href="/books/NBK65446/figure/appendixes.app20.f1/?report=objectonly" target="object" title="Figure 1" class="img_link icnblk_img figpopup" rid-figpopup="figappendixesapp20f1" rid-ob="figobappendixesapp20f1"><img class="small-thumb" src="/books/NBK65446/bin/app20f1.gif" src-large="/books/NBK65446/bin/app20f1.jpg" alt="Figure 1. Genetic Testing Decision model." /></a><div class="icnblk_cntnt" id="figlgndappendixesapp20f1"><h4 id="appendixes.app20.f1"><a href="/books/NBK65446/figure/appendixes.app20.f1/?report=objectonly" target="object" rid-ob="figobappendixesapp20f1">Figure 1</a></h4><p class="float-caption no_bottom_margin">Genetic Testing Decision model. </p></div></div><p>If genetic screening is available then only a proportion of women eligible for the program will be carriers of the BRCA1/2 genetic mutation. For women that enter the program and undergo testing, the test provides either a positive or negative result. The model also allows for the possibility that women enter the program but decide not to undergo testing. Following testing a woman may decide to undergo prophylactic surgery (either <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a> and/or <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a>) in order to reduce her <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> of breast and ovarian cancer. Four Markov states are included in the model; no cancer, breast cancer, ovarian cancer and death. The model runs annually for a maximum of fifty cycles.</p><p>The analysis is undertaken from a health service perspective for women aged 25, 35, 45, and 65 years of age. Health benefits are expressed in terms of Quality Adjusted Life Years (QALYS). Costs are discounted at 6% per annum and benefits are discounted at 1.5% per annum. Costs are expressed in 2002 UK sterling.</p><p>Assumptions of the model:</p><ul><li class="half_rhythm"><div>Breast cancer and ovarian cancer cannot be experienced simultaneously</div></li><li class="half_rhythm"><div>Prophylactic surgery, if undertaken, is immediate</div></li><li class="half_rhythm"><div>Prophylactic <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a> is only undertaken in conjunction with prophylactic <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a></div></li><li class="half_rhythm"><div>Women in a cancer state experience a constant decrement in Quality of life whilst in that state. There is distinction made between different stages of disease</div></li><li class="half_rhythm"><div>Women that undergo prophylactic surgery experience a constant decrement in quality of life.</div></li><li class="half_rhythm"><div>Reductions in quality of life from prophylactic surgery and cancer states are multiplicative</div></li><li class="half_rhythm"><div>Cancer states may be experienced for a maximum of 5 years. Women that have not progressed to death after 5 years return to the normal health state</div></li><li class="half_rhythm"><div>Progression from the normal health state to cancer states is not dependent on previous health states i.e. the model has no memory</div></li><li class="half_rhythm"><div>No account is taken of the possible gains that might accrue from individuals choosing not to undergo surgery given the information from a negative test who would have undergone surgery if no test were available</div></li><li class="half_rhythm"><div>No genetic testing takes place without counselling</div></li></ul></div><div id="appendixes.app20.s3"><h2 id="_appendixes_app20_s3_">Values used in the analysis</h2><p>A table of base case values and sources is provided in <a class="figpopup" href="/books/NBK65446/table/appendixes.app20.t1/?report=objectonly" target="object" rid-figpopup="figappendixesapp20t1" rid-ob="figobappendixesapp20t1">Table A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figappendixesapp20t1"><a href="/books/NBK65446/table/appendixes.app20.t1/?report=objectonly" target="object" title="Table A" class="img_link icnblk_img figpopup" rid-figpopup="figappendixesapp20t1" rid-ob="figobappendixesapp20t1"><img class="small-thumb" src="/books/NBK65446/table/appendixes.app20.t1/?report=thumb" src-large="/books/NBK65446/table/appendixes.app20.t1/?report=previmg" alt="Table A. Base case results for Genetic Testing Model (£'s per QALY)." /></a><div class="icnblk_cntnt"><h4 id="appendixes.app20.t1"><a href="/books/NBK65446/table/appendixes.app20.t1/?report=objectonly" target="object" rid-ob="figobappendixesapp20t1">Table A</a></h4><p class="float-caption no_bottom_margin">Base case results for Genetic Testing Model (£'s per QALY). </p></div></div><p>If genetic testing is available then women will be eligible for the program dependent on their level of <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a>. Clearly, the effectiveness and cost-effectiveness will differ according to the threshold at which this risk level is set. This threshold determines the probability that a woman is BRCA1/2 positive. The base case model uses a value of 0.15, which corresponds to the level of risk associated with women whose <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> corresponds to the “high” risk definition used in the guideline, <a href="/books/n/nicecg14/references.rl1/#references.r251" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r251/" data-bk-pop-others="" class="bk_pop">Sevilla et al. (2002)</a>.</p><p>For each woman entering the program, it is assumed that a preliminary counselling session is required. The cost of this session (£49.84) has been taken from Cohen et al. (in submission) In order to test for BRCA mutations an affected family member is tested to see if a family mutation can be found. In the base case analysis it is assumed that 100% of individuals entering the program have a living affected relative that is willing to be tested. This will depend on the criteria adopted for entry to the program. In the TRACE trial, for example, only 36 out of 48 women had such a relative (75%) and this value is used in the sensitivity analysis. It is recognised that the TRACE trial was not a trial of full <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">gene</a> testing. However, some of the cost elements are common to alternative testing programs.</p><p>The cost of this test is that for full sequencing in Manchester (Evans personal communication). Where a family mutation is detected in the affected woman then family members can be tested. Therefore, the cost per woman will depend both on the cost of the subsequent testing and the number of relatives that undergo testing per affected relative. We assume that a mean of two relatives will be tested per affected woman found positive. The unit cost for testing unaffected women is £28.84 for single batch cascade testing from the TRACE trial. Additionally, a positive test in the affected relative requires appropriate counselling to be provided both to that relative and to the unaffected relatives. This cost was estimated at £115.78 (Cohen et al. in submission - table 5 excluding patient travel costs) for affected women, plus £148.21 for pre and post test counselling in the unaffected relative.</p><p>The sensitivity and specificity of full <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">gene</a> sequencing is taken from myriad genetics (quoted in <a href="/books/n/nicecg14/references.rl1/#references.r269" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r269/" data-bk-pop-others="" class="bk_pop">Tengs and Berry 2000</a>). Women that receive a positive test result are more likely to undergo <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> reducing surgery (either <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a>, or mastectomy and <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a>) with these probabilities taken from Evans (personal communication). Expected health outcomes are therefore dependent on age dependent cancer risks and other cause mortality (ONS, <a href="/books/n/nicecg14/references.rl1/#references.r262" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r262/" data-bk-pop-others="" class="bk_pop">Stratton et al 1998</a>, <a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al 2002</a>), adjusted according to true BRCA1/2 status and whether risk reducing surgery has been taken. Quality of life values for all cancer and risk reducing surgery states are taken from <a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al. (2002)</a> and <a href="/books/n/nicecg14/references.rl1/#references.r268" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r268/" data-bk-pop-others="" class="bk_pop">Tengs et al (1998)</a>.</p><p>Costs for cancer states and prophylactic surgery are taken from NHS reference costs (2002). Cancer costs accrue are assumed to accrue for each year that a person remains in a cancer state.</p></div><div id="appendixes.app20.s4"><h2 id="_appendixes_app20_s4_">Results</h2><p>Base case results, shown in <a class="figpopup" href="/books/NBK65446/table/appendixes.app20.t1/?report=objectonly" target="object" rid-figpopup="figappendixesapp20t1" rid-ob="figobappendixesapp20t1">Table A</a>, show that genetic testing women at a very young age is dominated compared to a no testing alternative. The reason for this is that the model assumes that those women that undertake <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> reducing surgery do so immediately. At a young age the risk of breast or ovarian cancer is relatively low compared to the reduction in quality of life suffered from risk reducing surgery. The benefits of risk reducing surgery are experienced to a greater extent in later years and are consequently not valued particularly highly due to discounting.</p><p>The base case results for testing at all other ages (except 65 years and over) indicate that health benefits are generated at a relatively low additional cost. The cost per QALY is relatively high (£55k) for women aged 65 years. The reason for this is that whilst the costs of providing testing and surgery are immediate (financial and quality of life reduction for women), the benefits occur in later years (reduced incidence of disease). However, all cause mortality in older women is obviously higher and therefore the benefits accrued in future years are limited.</p></div><div id="appendixes.app20.s5"><h2 id="_appendixes_app20_s5_">Sensitivity analyses</h2><p>Only simple, one-way sensitivity analyses have been performed with the aim of showing those key estimates that have substantial impact on the model. Results are shown in <a class="figpopup" href="/books/NBK65446/table/appendixes.app20.t2/?report=objectonly" target="object" rid-figpopup="figappendixesapp20t2" rid-ob="figobappendixesapp20t2">Table B</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figappendixesapp20t2"><a href="/books/NBK65446/table/appendixes.app20.t2/?report=objectonly" target="object" title="Table B" class="img_link icnblk_img figpopup" rid-figpopup="figappendixesapp20t2" rid-ob="figobappendixesapp20t2"><img class="small-thumb" src="/books/NBK65446/table/appendixes.app20.t2/?report=thumb" src-large="/books/NBK65446/table/appendixes.app20.t2/?report=previmg" alt="Table B. Sensitivity Analyses for genetic Testing Model (£’s per QALY)." /></a><div class="icnblk_cntnt"><h4 id="appendixes.app20.t2"><a href="/books/NBK65446/table/appendixes.app20.t2/?report=objectonly" target="object" rid-ob="figobappendixesapp20t2">Table B</a></h4><p class="float-caption no_bottom_margin">Sensitivity Analyses for genetic Testing Model (£’s per QALY). </p></div></div><p>Firstly, it can be seen that the results are relatively insensitive to the probability that a woman entering the scheme has an affected relative and therefore receives the test.</p><p>The prior probability of women entering the program having genetic mutations has a substantial impact. If the true proportion is 20% instead of 15% then, except in women aged 25 and below, then testing becomes a relatively cost effective option and in some case (women aged 45 and 55 years) dominates the no test option. <a class="figpopup" href="/books/NBK65446/table/appendixes.app20.t2/?report=objectonly" target="object" rid-figpopup="figappendixesapp20t2" rid-ob="figobappendixesapp20t2">Table B</a> also shows that the results are sensitive to the QALY values used for the relevant health states, to the proportion of women that undertake <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> reducing surgery that would not have done so in the absence of genetic testing and to the cost of the test. For the latter value, the Myriad quoted cost was used although the result here may not be a completely accurate reflection of such testing arrangements since the myriad system would not require the involvement of affected relatives.</p></div><div id="appendixes.app20.s6"><h2 id="_appendixes_app20_s6_">Discussion and Limitations</h2><p>There is no combined ovarian and breast cancer health state in the model.</p><p>It is assumed that no women undergo <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> reducing <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a> without <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a>.</p><p>There is little evidence that genetic testing alters the likelihood that women undergo <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> reducing surgery (or any other type of risk reducing behaviour that is not accounted for in the model). These estimates are therefore extremely uncertain.</p><p>No comparison of different genetic testing programs has been undertaken. <a href="/books/n/nicecg14/references.rl1/#references.r251" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r251/" data-bk-pop-others="" class="bk_pop">Sevilla et al (2002)</a> suggest that the incremental cost effectiveness of some full <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">gene</a> testing programs is extremely high compared to less sensitive/specific alternatives. Such an analysis should be undertaken from an NHS perspective.</p><p>Only health benefits are included in the model. There may be an inherent value of information and there is also likely to be utility in waiting less time for results. If this wider perspective were adopted then it would be important to compare different types of genetic testing, including the private provision of testing by Myriad genetics (for example, comprehensive BRCA testing results can be received in 10 days for a unit cost of $4,140).</p><p>The costs and benefits associated with breast and ovarian cancers are relatively crude.</p><p>The results for women aged 25 years should <u>not</u> be interpreted as an indication that genetic testing is not cost-effective at this age but that surgery undertaken in the light of additional information may be best delayed (as many women choose currently).</p><div id="appendixes.app20.tu1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65446/table/appendixes.app20.tu1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__appendixes.app20.tu1_lrgtbl__"><table><thead><tr><th id="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Parameter</th><th id="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:bottom;">Value</th><th id="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Source</th></tr></thead><tbody><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability that woman entering the program is BRCA1/2</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">+ve</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.15</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sevilla et al.</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity of test</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.98</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Myriad genetics</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity of test</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.99</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Myriad genetics</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality Rates (per 1000 population per year) for women by age</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ONS</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">35–44</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1.51</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">45–54</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.93</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">55–64</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">10.9</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">65–74</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">31.6</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">75–84</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">80.1</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">85 and over</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">187.9</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rates of breast cancer by age</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ONS</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">25</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">6.67E-05</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">26–30</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.000526</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">31–40</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.005</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">41–50</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.02</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">51–60</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.043478</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">61–70</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.066667</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">71–80</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.090909</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">81–85</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.1</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rates of ovarian cancer by age</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ONS</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">25</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00002</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">26–30</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00004</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">31–40</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00007</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">41–50</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.0002</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">51–60</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00046</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">61–70</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00075</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">71–80</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00076</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">81–85</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.00061</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 year survival breast cancer</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ONS</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">less than 40</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.7</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">40–49</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.78</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">50–59</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.8</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">60–69</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.78</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">70–79</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.68</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">80–99</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.48</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 year survival ovarian cancer</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ONS</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">less than 40</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.69</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">40–49</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.43</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">50–59</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.34</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">60–69</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.25</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">70–79</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.17</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">80–99</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.12</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d13/">Lifetime risk</a> breast cancer BRCA carrier</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.84</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guideline</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> ovarian cancer BRCA carrier</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">27.05</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Easton et al. quoted in <a href="/books/n/nicecg14/references.rl1/#references.r96" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r96/" data-bk-pop-others="" class="bk_pop">Grann et al. (2000)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> breast cancer after prophylactic <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.1</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guideline evidence statement</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> breast cancer after prophylactic <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.37</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Guideline evidence statement</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> ovarian cancer after prophylactic <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.04</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al. (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability of <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a> and <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a> following positive test result</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.25</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evans (personal communication)</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability of <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">mastectomy</a> after positive test result</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.5</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evans (personal communication)</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b><i>QALYs</i></b></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">Mastectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.76</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a> (before 50 with hormone replacement)</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.82</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a> (before 50 without hormone replacement)</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.8</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mast and ooph</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.73</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Breast cancer</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.77</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ovarian cancer</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.65</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a href="/books/n/nicecg14/references.rl1/#references.r95" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r95/" data-bk-pop-others="" class="bk_pop">Grann et al (2002)</a></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b><i>Costs</i></b></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;"></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Genetic testing cost in affected woman - Whole <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">Gene</a> NHS</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">891.17</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Evans personal communication</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Genetic testing in affected woman - Myriad</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1569.6</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Myriad genetics personal communication (adjusted to UK sterling using OECD PPP)</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d15/">Mastectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1989</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs J02</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Breast cancer treatment each year</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2387</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs J09</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d18/">oophorectomy</a></td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2144</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs M07</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ovarian cancer treatment cost each year</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">588</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs M98</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of women in family tested per affected relative</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assumption</td></tr><tr><td headers="hd_h_appendixes.app20.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cost of counselling</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">49.84</td><td headers="hd_h_appendixes.app20.tu1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cohen et al. (2003)</td></tr></tbody></table></div></div></div><div><h2 id="NBK65446_footnotes">Footnotes</h2><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="appendixes.app20.fn1"><p class="no_top_margin">1998–2003 Treeage Software Inc.</p></div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
|
|
<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2004, School of Health and Related Research (ScHARR), University of Sheffield.</div><div class="small"><span class="label">Bookshelf ID: NBK65446</span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/nicecg14/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg14/appendixes.app19/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg14/appendixes.app21/" title="Next page in this title">Next ></a></div></div></div></div>
|
|
|
|
</div>
|
|
|
|
<!-- Custom content below content -->
|
|
<div class="col4">
|
|
|
|
</div>
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<!-- Custom contetnt below bottom nav -->
|
|
<div class="col5">
|
|
|
|
</div>
|
|
</div>
|
|
|
|
<div id="rightcolumn" class="four_col col last">
|
|
<!-- Custom content above discovery portlets -->
|
|
<div class="col6">
|
|
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK65446&db=books">Share</a></div>
|
|
|
|
</div>
|
|
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65446/?report=reader">PubReader</a></li><li><a href="/books/NBK65446/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65446" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65446" style="display:none" title="Cite this Page"><div class="bk_tt">School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet]. Sheffield (UK): University of Sheffield; 2004 May. (NICE Clinical Guidelines, No. 14.) Appendix 20, Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2.<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/n/nicecg14/pdf/">PDF version of this title</a> (7.0M)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#appendixes.app20.s1" ref="log$=inpage&link_id=inpage">Background</a></li><li><a href="#appendixes.app20.s2" ref="log$=inpage&link_id=inpage">Overview of model</a></li><li><a href="#appendixes.app20.s3" ref="log$=inpage&link_id=inpage">Values used in the analysis</a></li><li><a href="#appendixes.app20.s4" ref="log$=inpage&link_id=inpage">Results</a></li><li><a href="#appendixes.app20.s5" ref="log$=inpage&link_id=inpage">Sensitivity analyses</a></li><li><a href="#appendixes.app20.s6" ref="log$=inpage&link_id=inpage">Discussion and Limitations</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Other titles in this collection</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/nicecollect/">National Institute for Health and Clinical Excellence: Guidance
|
|
</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related NICE guidance and evidence</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/nicecg41/">NICE Clinical Guideline 41: Familial Breast Cancer: The Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care: Update</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67d7a33084f3725e592bda44">Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2 - Clinical ...</a><div class="ralinkpop offscreen_noflow">Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2 - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67d7a32f67c23b31e0b0cd55">Smoking - Clinical Guidelines for the Classification and Care of Women at Risk o...</a><div class="ralinkpop offscreen_noflow">Smoking - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67d7a32f2f30673f7bff5aaa">Obesity - Clinical Guidelines for the Classification and Care of Women at Risk o...</a><div class="ralinkpop offscreen_noflow">Obesity - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67d7a32e2f30673f7bff5263">Alcohol consumption - Clinical Guidelines for the Classification and Care of Wom...</a><div class="ralinkpop offscreen_noflow">Alcohol consumption - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67d7a32dcde49f3df7e52841">Other reproductive/fertility issues - Clinical Guidelines for the Classification...</a><div class="ralinkpop offscreen_noflow">Other reproductive/fertility issues - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
|
|
|
<!-- Custom content below discovery portlets -->
|
|
<div class="col7">
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Custom content after all -->
|
|
<div class="col8">
|
|
|
|
</div>
|
|
<div class="col9">
|
|
|
|
</div>
|
|
|
|
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
|
<script type="text/javascript">
|
|
(function($){
|
|
$('.skiplink').each(function(i, item){
|
|
var href = $($(item).attr('href'));
|
|
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
|
$(item).on('click', function(event){
|
|
event.preventDefault();
|
|
$.scrollTo(href, 0, {
|
|
onAfter: function(){
|
|
href.focus();
|
|
}
|
|
});
|
|
});
|
|
});
|
|
})(jQuery);
|
|
</script>
|
|
</div>
|
|
<div class="bottom">
|
|
|
|
<div id="NCBIFooter_dynamic">
|
|
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
|
<component id="Breadcrumbs" label="helpdesk"/>-->
|
|
|
|
</div>
|
|
|
|
<div class="footer" id="footer">
|
|
<section class="icon-section">
|
|
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
|
<div class="grid-container container">
|
|
<div class="icon-section_container">
|
|
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11 {
|
|
fill: #737373;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>Twitter</title>
|
|
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>Facebook</title>
|
|
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>LinkedIn</title>
|
|
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11,
|
|
.cls-12 {
|
|
fill: #737373;
|
|
}
|
|
|
|
.cls-11 {
|
|
fill-rule: evenodd;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>GitHub</title>
|
|
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
|
</path>
|
|
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
|
</path>
|
|
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
|
</path>
|
|
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
|
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
|
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
|
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
|
<title>NCBI Insights Blog</title>
|
|
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
|
</svg>
|
|
</a>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
|
|
<section class="container-fluid bg-primary">
|
|
<div class="container pt-5">
|
|
<div class="row mt-3">
|
|
<div class="col-lg-3 col-12">
|
|
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
|
<ul class="list-inline social_media">
|
|
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st20 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st30 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Twitter</title>
|
|
<g>
|
|
<g>
|
|
<g>
|
|
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
|
</g>
|
|
</svg></a></li>
|
|
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
|
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st10 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st110 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Facebook</title>
|
|
<g>
|
|
<g>
|
|
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
|
</svg>
|
|
</a></li>
|
|
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<title>Youtube</title>
|
|
<style type="text/css">
|
|
.st4 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
|
|
.st5 {
|
|
fill: #FFFFFF;
|
|
}
|
|
</style>
|
|
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
|
<g transform="translate(0,-952.36218)">
|
|
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
|
</g>
|
|
</svg></a></li>
|
|
</ul>
|
|
</div>
|
|
<div class="col-lg-3 col-12">
|
|
<p class="address_footer text-white">National Library of Medicine<br />
|
|
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
|
Bethesda, MD 20894</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
|
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
|
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
|
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
|
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="col-lg-12 centered-lg">
|
|
<nav class="bottom-links">
|
|
<ul class="mt-3">
|
|
<li>
|
|
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
|
</li>
|
|
</ul>
|
|
</nav>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!--/.page-->
|
|
</div>
|
|
<!--/.wrap-->
|
|
</div><!-- /.twelve_col -->
|
|
</div>
|
|
<!-- /.grid -->
|
|
|
|
<span class="PAFAppResources"></span>
|
|
|
|
<!-- BESelector tab -->
|
|
|
|
|
|
|
|
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK65446&ncbi_domain=nicecg14&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK65446/&ncbi_pagename=Estimating the Cost Effectiveness of Genetic Testing for BRCA1/BRCA2 - Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care - NCBI Bookshelf&ncbi_bookparttype=appendix&ncbi_app=bookshelf" /></noscript>
|
|
|
|
|
|
<!-- usually for JS scripts at page bottom -->
|
|
<!--<component id="PageFixtures" label="styles"></component>-->
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal107 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
|
</html> |