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Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer

Author

Listed:
  • Dirk Müller

    (The University Hospital of Cologne (AöR))

  • Marion Danner

    (The University Hospital of Cologne (AöR))

  • Rita Schmutzler

    (University Hospital Cologne)

  • Christoph Engel

    (University of Leipzig)

  • Kirsten Wassermann

    (University Hospital Cologne)

  • Björn Stollenwerk

    (German Research Center for Environmental Health)

  • Stephanie Stock

    (The University Hospital of Cologne (AöR))

  • Kerstin Rhiem

    (University Hospital Cologne)

Abstract

Background The ‘German Consortium for Hereditary Breast and Ovarian Cancer’ (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test. Methods A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of ≥ 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states ‘well’ (women with increased risk), ‘breast cancer without metastases’, ‘breast cancer with metastases’, ‘ovarian cancer’, ‘death’, and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC. Results Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of €7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of €17,027 per QALY; cost per LYG: €22,318). The results were robust in deterministic and probabilistic sensitivity analyses. Conclusion The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of ≥ 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.

Suggested Citation

  • Dirk Müller & Marion Danner & Rita Schmutzler & Christoph Engel & Kirsten Wassermann & Björn Stollenwerk & Stephanie Stock & Kerstin Rhiem, 2019. "Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(5), pages 739-750, July.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:5:d:10.1007_s10198-019-01038-1
    DOI: 10.1007/s10198-019-01038-1
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    References listed on IDEAS

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    1. John A. Nyman, 2004. "Should the consumption of survivors be included as a cost in cost–utility analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 417-427, May.
    2. Peasgood, T & Ward, S & Brazier, J, 2010. "A review and meta-analysis of health state utility values in breast cancer," MPRA Paper 29950, University Library of Munich, Germany.
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    Cited by:

    1. Aruni Ghose & Anita Bolina & Ishika Mahajan & Syed Ahmer Raza & Miranda Clarke & Abhinanda Pal & Elisabet Sanchez & Kathrine Sofia Rallis & Stergios Boussios, 2022. "Hereditary Ovarian Cancer: Towards a Cost-Effective Prevention Strategy," IJERPH, MDPI, vol. 19(19), pages 1-18, September.

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    More about this item

    Keywords

    Cost-effectiveness; Economic modeling; Genetic testing; Breast cancer; Risk-reducing surgery; BRCA;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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