A Cost-Effectiveness Evaluation of Germline BRCA1 and BRCA2 Testing in UK Women with Ovarian Cancer.

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Date
2017-04Author
Eccleston, A
Bentley, A
Dyer, M
Strydom, A
Vereecken, W
George, A
Rahman, N
Type
Journal Article
Metadata
Show full item recordAbstract
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.
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Subject
Humans
Neoplasms, Glandular and Epithelial
Breast Neoplasms
Ovarian Neoplasms
Genetic Predisposition to Disease
BRCA1 Protein
BRCA2 Protein
Prognosis
Models, Economic
Risk Assessment
Risk Factors
Reproducibility of Results
Predictive Value of Tests
Pedigree
DNA Mutational Analysis
Heredity
Phenotype
Germ-Line Mutation
Decision Support Techniques
Quality-Adjusted Life Years
Time Factors
Computer Simulation
Adult
Aged
Middle Aged
Cost-Benefit Analysis
Health Care Costs
Female
Early Detection of Cancer
Genetic Testing
Biomarkers, Tumor
United Kingdom
Carcinoma, Ovarian Epithelial
Research team
Genetic Susceptibility
Language
eng
Date accepted
2017-01-11
License start date
2017-04
Citation
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2017, 20 (4), pp. 567 - 576