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Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia

Author

Listed:
  • Ka Keat Lim

    (Duke NUS Medical School
    National Clinical Research Centre)

  • Sook Yee Yoon

    (Cancer Research Malaysia)

  • Nur Aishah Mohd Taib

    (University of Malaya)

  • Fatiha Hana Shabaruddin

    (University of Malaya)

  • Maznah Dahlui

    (University of Malaya)

  • Yin Ling Woo

    (University of Malaya)

  • Meow Keong Thong

    (University of Malaya)

  • Soo Hwang Teo

    (Cancer Research Malaysia
    University of Malaya)

  • Nathorn Chaiyakunapruk

    (Naresuan University
    Monash University Malaysia
    Monash University Malaysia
    University of Wisconsin)

Abstract

Objective Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. Methods We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. Results In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. Conclusions Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.

Suggested Citation

  • Ka Keat Lim & Sook Yee Yoon & Nur Aishah Mohd Taib & Fatiha Hana Shabaruddin & Maznah Dahlui & Yin Ling Woo & Meow Keong Thong & Soo Hwang Teo & Nathorn Chaiyakunapruk, 2018. "Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia," Applied Health Economics and Health Policy, Springer, vol. 16(3), pages 395-406, June.
  • Handle: RePEc:spr:aphecp:v:16:y:2018:i:3:d:10.1007_s40258-018-0384-8
    DOI: 10.1007/s40258-018-0384-8
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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
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