PURPOSE: Women with ovarian cancer have a 10% probability of carrying a BRCA 
mutation. If a mutation is identified, unaffected family members can undergo 
genetic testing and cancer risk-reducing strategies. We estimated the net health 
benefits and cost-effectiveness of different criteria for BRCA mutation testing 
in women with ovarian cancer, and the downstream benefits for their first-degree 
relatives (FDRs).
METHODS: We developed a Markov Monte Carlo simulation model to compare four 
criteria for BRCA testing in women with ovarian cancer: no testing (reference); 
only if personal history of breast cancer, family history of breast/ovarian 
cancer, or Ashkenazi Jewish ancestry; only if invasive serous cancer; any 
invasive nonmucinous epithelial cancer. Net health benefit was life expectancy 
for FDRs and primary outcome was the incremental cost-effectiveness ratio 
(ICER). The model estimated the number of future breast and ovarian cancer cases 
in FDRs.
RESULTS: BRCA testing based on personal/family history and ancestry could 
prevent future cases in FDRs with an ICER of $32,018 per year of life (LY) 
gained compared with the reference strategy. BRCA testing based on serous or any 
nonmucinous epithelial ovarian cancer could prevent more cancer cases, but at 
ICERs of $128,465 and $148,363 per LY gained, respectively.
CONCLUSION: BRCA testing of women with ovarian cancer based on personal/family 
history of cancer or Ashkenazi Jewish ancestry is a cost-effective strategy to 
prevent future breast and ovarian cancers among FDRs. More inclusive testing 
strategies prevent additional cancer cases but at significant cost.