Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops
| Autor: | Matthew Dyer, Paul Hoskins, M. Hurry, Anthony Eccleston |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Oncology Canada medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Ovariectomy medicine.medical_treatment Genes BRCA2 Genes BRCA1 Breast Neoplasms Brca testing 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine medicine Humans Computer Simulation Genetic Testing 030212 general & internal medicine Mastectomy Ovarian Neoplasms business.industry Health Policy BRCA mutation Cancer Middle Aged medicine.disease Models Economic 030220 oncology & carcinogenesis Female Quality-Adjusted Life Years Cancer development Ovarian cancer business |
| Zdroj: | International Journal of Technology Assessment in Health Care. 36:104-112 |
| ISSN: | 1471-6348 0266-4623 |
| DOI: | 10.1017/s0266462319003519 |
| Popis: | ObjectivesTo assess the cost effectiveness from a Canadian perspective of index patient germline BRCA testing and then, if positive, family members with subsequent risk-reducing surgery (RRS) in as yet unaffected mutation carriers compared with no testing and treatment of cancer when it develops.MethodsA patient level simulation was developed comparing outcomes between two groups using Canadian data. Group 1: no mutation testing with treatment if cancer developed. Group 2: cascade testing (index patient BRCA tested and first-/second-degree relatives tested if index patient/first-degree relative is positive) with RRS in carriers. End points were the incremental cost-effectiveness ratio (ICER) and budget impact.ResultsThere were 29,102 index patients: 2,786 ovarian cancer and 26,316 breast cancer (BC). Using the base-case assumption of 44 percent and 21 percent of women with a BRCA mutation receiving risk-reducing bilateral salpingo-oophorectomy and risk-reducing mastectomy, respectively, testing was cost effective versus no testing and treatment on cancer development, with an ICER of CAD 14,942 (USD 10,555) per quality-adjusted life-year (QALY), 127 and 104 fewer cases of ovarian and BC, respectively, and twenty-one fewer all-cause deaths. Testing remained cost effective versus no testing at the commonly accepted North American threshold of approximately CAD 100,000 (or USD 100,000) per QALY gained in all scenario analyses, and cost effectiveness improved as RRS uptake rates increased.ConclusionsPrevention via testing and RRS is cost effective at current RRS uptake rates; however, optimization of uptake rates and RRS will increase cost effectiveness and can provide cost savings. |
| Databáze: | OpenAIRE |
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