A Cost-Effectiveness Evaluation of Germline BRCA1 and BRCA2 Testing in UK Women with Ovarian Cancer.
Value Health
; 20(4): 567-576, 2017 04.
Article
em En
| MEDLINE
| ID: mdl-28407998
ABSTRACT
OBJECTIVES:
To evaluate the long-term cost-effectiveness of germline BRCA1 and BRCA2 (collectively termed "BRCA") testing in women with epithelial ovarian cancer, and testing for the relevant mutation in first- and second-degree relatives of BRCA mutation-positive individuals, compared with no testing. Female BRCA mutation-positive relatives of patients with ovarian cancer could undergo risk-reducing mastectomy and/or bilateral salpingo-oophorectomy.METHODS:
A cost-effectiveness model was developed that included the risks of breast and ovarian cancer; the costs, utilities, and effects of risk-reducing surgery on cancer rates; and the costs, utilities, and mortality rates associated with cancer.RESULTS:
BRCA testing of all women with epithelial ovarian cancer each year is cost-effective at a UK willingness-to-pay threshold of £20,000/quality-adjusted life-year (QALY) compared with no testing, with an incremental cost-effectiveness ratio of £4,339/QALY. The result was primarily driven by fewer cases of breast cancer (142) and ovarian cancer (141) and associated reductions in mortality (77 fewer deaths) in relatives over the subsequent 50 years. Sensitivity analyses showed that the results were robust to variations in the input parameters. Probabilistic sensitivity analysis showed that the probability of germline BRCA mutation testing being cost-effective at a threshold of £20,000/QALY was 99.9%.CONCLUSIONS:
Implementing germline BRCA testing in all patients with ovarian cancer would be cost-effective in the United Kingdom. The consequent reduction in future cases of breast and ovarian cancer in relatives of mutation-positive individuals would ease the burden of cancer treatments in subsequent years and result in significantly better outcomes and reduced mortality rates for these individuals.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
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2_ODS3
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6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Ovarianas
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Neoplasias da Mama
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Análise Mutacional de DNA
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Biomarcadores Tumorais
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Testes Genéticos
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Custos de Cuidados de Saúde
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Mutação em Linhagem Germinativa
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Neoplasias Epiteliais e Glandulares
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Proteína BRCA1
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Proteína BRCA2
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Aspecto:
Patient_preference
País/Região como assunto:
Europa
Idioma:
En
Revista:
Value Health
Ano de publicação:
2017
Tipo de documento:
Article