Offering Genetic Counseling Before Testing Saves Money, Reduces Unnecessary Tests

Patients who receive genetic counseling before they undergo testing are educated about these tests and may have fewer unnecessary procedures, according to results of a study from Moffitt Cancer Center, and published in Genetics in Medicine.

The study assessed the potential differences in genetic counseling services delivered by board-certified genetic health-care providers versus non—genetic health-care providers. It also evaluated patient recall and the content of pre-test genetic counseling, as well as whether full genetic testing was performed when a less expensive test was sufficient.

At Moffitt, researchers surveyed 473 patients who underwent testing for the gene mutations, BRCA1 and BRCA2, which are associated with increased risk of breast and ovarian cancers. Of the 276 (58%) with genetic health care provider involvement, 97% recalled a pretest discussion as compared with 59% of those without genetic health care provider involvement. These findings suggest large differences in quality of care across providers who order testing.

The researchers noted that when genetic health care providers are involved, they are less like to order more expensive comprehensive genetic testing, especially when less expensive tests may be appropriate.

“Our study found that in cases where less expensive testing may be appropriate, genetic health care providers ordered comprehensive testing for 9.5% of participants, compared to 19.4% when tests were ordered by other health care providers,” said Deborah Cragun, PhD, lead study author in a news release. “At the time of data collection, comprehensive genetic testing cost approximately $4,000, compared to $400 for the less expensive testing,” she said.

The findings are important, noted researchers, because costs and quality of care are often the focus of policy-level decisions in health care.

Up to 10% of cancers are inherited, meaning a person was born with an abnormal gene that increases their risk for cancer. “Pre-test genetic counseling in which a health care provider takes a thorough family history and discusses the potential risks and benefits of genetic testing is standard of care as recommended by the American Society of Clinical Oncology and National Society of Genetic Counselors,” said Tuya Pal, MD, a board-certified geneticist at Moffitt and senior author of the paper.

Source:

Cragun D, Camperlengo L, Robinson E, Caldwell M, Jongphil K, Phelan C, et al. Differences in BRCA counseling and testing practices based on ordering provider type. Genetics in Med; 2014; Published online 12 June 2014. http://www.nature.com/gim/journal/vaop/ncurrent/full/gim201475a.html#access