Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops
To 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. A patient le...
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| Veröffentlicht in: | International journal of technology assessment in health care 2020-04, Vol.36 (2), p.104-112 |
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| creator | Hurry, Manjusha Eccleston, Anthony Dyer, Matthew Hoskins, Paul |
| description | To 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.
A 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.
There 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.
Prevention 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. |
| doi_str_mv | 10.1017/S0266462319003519 |
| format | Article |
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A 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.
There 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.
Prevention 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.</description><identifier>ISSN: 0266-4623</identifier><identifier>EISSN: 1471-6348</identifier><identifier>DOI: 10.1017/S0266462319003519</identifier><identifier>PMID: 32423520</identifier><language>eng</language><publisher>England: Cambridge University Press</publisher><subject>Adult ; Age ; Breast cancer ; Breast Neoplasms - economics ; Breast Neoplasms - genetics ; Breast Neoplasms - prevention & control ; Canada ; Cancer therapies ; Computer Simulation ; Cost analysis ; Cost effectiveness ; Cost-Benefit Analysis ; Families & family life ; Female ; Females ; Genes, BRCA1 ; Genes, BRCA2 ; Genetic counseling ; Genetic Testing - economics ; Genetic Testing - methods ; Humans ; Mastectomy - economics ; Mastectomy - statistics & numerical data ; Middle Aged ; Models, Economic ; Mortality ; Mutation ; Normal distribution ; Optimization ; Ovarian cancer ; Ovarian Neoplasms - economics ; Ovarian Neoplasms - genetics ; Ovarian Neoplasms - prevention & control ; Ovariectomy ; Ovariectomy - economics ; Ovariectomy - statistics & numerical data ; Patients ; Population ; Prevention ; Quality-Adjusted Life Years ; Risk ; Surgery</subject><ispartof>International journal of technology assessment in health care, 2020-04, Vol.36 (2), p.104-112</ispartof><rights>2020 This article is published under (https://creativecommons.org/licenses/by/3.0/) (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-d2c818506b0d3cee701dbb95bfcb27769146b9cee5cadb741a44370c6e2967ef3</citedby><cites>FETCH-LOGICAL-c372t-d2c818506b0d3cee701dbb95bfcb27769146b9cee5cadb741a44370c6e2967ef3</cites><orcidid>0000-0002-9018-8304</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32423520$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hurry, Manjusha</creatorcontrib><creatorcontrib>Eccleston, Anthony</creatorcontrib><creatorcontrib>Dyer, Matthew</creatorcontrib><creatorcontrib>Hoskins, Paul</creatorcontrib><title>Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops</title><title>International journal of technology assessment in health care</title><addtitle>Int J Technol Assess Health Care</addtitle><description>To 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.
A 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.
There 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.
Prevention 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.</description><subject>Adult</subject><subject>Age</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - economics</subject><subject>Breast Neoplasms - genetics</subject><subject>Breast Neoplasms - prevention & control</subject><subject>Canada</subject><subject>Cancer therapies</subject><subject>Computer Simulation</subject><subject>Cost analysis</subject><subject>Cost effectiveness</subject><subject>Cost-Benefit Analysis</subject><subject>Families & family life</subject><subject>Female</subject><subject>Females</subject><subject>Genes, BRCA1</subject><subject>Genes, BRCA2</subject><subject>Genetic counseling</subject><subject>Genetic Testing - economics</subject><subject>Genetic Testing - methods</subject><subject>Humans</subject><subject>Mastectomy - economics</subject><subject>Mastectomy - 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Academic</collection><jtitle>International journal of technology assessment in health care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hurry, Manjusha</au><au>Eccleston, Anthony</au><au>Dyer, Matthew</au><au>Hoskins, Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops</atitle><jtitle>International journal of technology assessment in health care</jtitle><addtitle>Int J Technol Assess Health Care</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>36</volume><issue>2</issue><spage>104</spage><epage>112</epage><pages>104-112</pages><issn>0266-4623</issn><eissn>1471-6348</eissn><abstract>To 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.
A 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.
There 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.
Prevention 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.</abstract><cop>England</cop><pub>Cambridge University Press</pub><pmid>32423520</pmid><doi>10.1017/S0266462319003519</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9018-8304</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Age Breast cancer Breast Neoplasms - economics Breast Neoplasms - genetics Breast Neoplasms - prevention & control Canada Cancer therapies Computer Simulation Cost analysis Cost effectiveness Cost-Benefit Analysis Families & family life Female Females Genes, BRCA1 Genes, BRCA2 Genetic counseling Genetic Testing - economics Genetic Testing - methods Humans Mastectomy - economics Mastectomy - statistics & numerical data Middle Aged Models, Economic Mortality Mutation Normal distribution Optimization Ovarian cancer Ovarian Neoplasms - economics Ovarian Neoplasms - genetics Ovarian Neoplasms - prevention & control Ovariectomy Ovariectomy - economics Ovariectomy - statistics & numerical data Patients Population Prevention Quality-Adjusted Life Years Risk Surgery |
| title | Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops |
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