Most Women Not Willing to Pay for Genetic Breast Cancer Testing

Caroline Helwick

February 2013, Vol 4, No 2 - Health Economics


San Antonio, TX—Direct-to-consumer (DTC) genetic testing using single nucleotide polymorphisms (SNPs) is of interest to women who are concerned about breast cancer; however, these women are unwilling to pay the current costs, researchers from the Department of Surgery and Institute for Health Policy Studies, University of California, San Francisco (UCSF), Medical Center, reported at the 2012 CTRC-AACR San Antonio

Breast Cancer Symposium.
SNP testing identifies genetic variations that may be correlated with a risk for breast cancer and could be seen as a personalized tool in breast cancer prevention through more precise risk assessment. DTC SNP has been marketed aggressively. However, little is known about how women respond to this information, according to lead investigator Rebecca Howe, a UCSF researcher. 

“DTC SNP testing may place a burden on physicians and other providers to discuss and help interpret DTC SNP results with their patients,” Ms Howe said.

Ms Howe and colleagues studied patient interest in these kits, as well as their willingness to pay for SNP testing. The study included 189 women (mean age, 49 years) from the national Cancer Genetics Network.

The women had no personal history of breast cancer but did have a family history of breast cancer or ovarian cancer. Of those who tested positive, 31% had received BRCA testing, 8% of whom tested positive for BRCA1 and 3% tested positive for BRCA2 mutations. BRCA1 and BRCA2 mutations were found in family members of 13% and 7% of the women, respectively.

Table
 Survey Results (N = 189).
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The women completed an online questionnaire that probed their knowledge and interest in DTC SNP testing and their willingness to pay for it (Table).

“Women wanted to discuss testing results with a provider (77% if above-average risk, and 59% if below-average), and they were interested in lifestyle interventions to reduce their risk (96% if above average and 69% if below). There was also a strong interest in regular mammograms even for women with below-average risk,” Ms Howe noted.

Approximately 70% of the women with below-average risk selected “none” when asked for their intervention choices. “The significant interest in lifestyle changes suggests that this intervention should be included in risk reduction conversations,” Ms Howe pointed out.

Women Not Willing to Pay
But although the women were overall interested in SNP testing, they were generally not willing to pay for it, she said. Of those surveyed, 40% were willing to pay $100, approximately 10% were willing to pay $200, and 10% would pay $500.

Only approximately 5% would pay $1000 for SNP testing. The survey revealed that the average willingness to pay was $125.

Trust of DTC SNP testing (P = .004), very high interest in testing (P <.001), and family history of BRCA1 mutation (P = .005) were associated with willingness to pay a higher amount. Age, education level, Ashkenazi Jewish heritage, and the number of relatives with breast or ovarian cancers were not significant predictors of willingness to pay.

“The majority of women in our sample are interested in this type of genetic testing, but most are unwilling to pay the current cost of a DTC SNP testing kit,” Ms Howe acknowledged.