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dc.contributor.authorEccleston, A
dc.contributor.authorBentley, A
dc.contributor.authorDyer, M
dc.contributor.authorStrydom, A
dc.contributor.authorVereecken, W
dc.contributor.authorGeorge, A
dc.contributor.authorRahman, N
dc.date.accessioned2018-02-16T09:31:19Z
dc.date.issued2017-04
dc.identifier.citationValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2017, 20 (4), pp. 567 - 576
dc.identifier.issn1098-3015
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1159
dc.identifier.eissn1524-4733
dc.identifier.doi10.1016/j.jval.2017.01.004
dc.description.abstractObjectives 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.
dc.formatPrint-Electronic
dc.format.extent567 - 576
dc.languageeng
dc.language.isoeng
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.subjectHumans
dc.subjectNeoplasms, Glandular and Epithelial
dc.subjectBreast Neoplasms
dc.subjectOvarian Neoplasms
dc.subjectGenetic Predisposition to Disease
dc.subjectBRCA1 Protein
dc.subjectBRCA2 Protein
dc.subjectPrognosis
dc.subjectModels, Economic
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectReproducibility of Results
dc.subjectPredictive Value of Tests
dc.subjectPedigree
dc.subjectDNA Mutational Analysis
dc.subjectHeredity
dc.subjectPhenotype
dc.subjectGerm-Line Mutation
dc.subjectDecision Support Techniques
dc.subjectQuality-Adjusted Life Years
dc.subjectTime Factors
dc.subjectComputer Simulation
dc.subjectAdult
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectCost-Benefit Analysis
dc.subjectHealth Care Costs
dc.subjectFemale
dc.subjectEarly Detection of Cancer
dc.subjectGenetic Testing
dc.subjectBiomarkers, Tumor
dc.subjectUnited Kingdom
dc.subjectCarcinoma, Ovarian Epithelial
dc.titleA Cost-Effectiveness Evaluation of Germline BRCA1 and BRCA2 Testing in UK Women with Ovarian Cancer.
dc.typeJournal Article
dcterms.dateAccepted2017-01-11
rioxxterms.versionofrecord10.1016/j.jval.2017.01.004
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0
rioxxterms.licenseref.startdate2017-04
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfValue in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
pubs.issue4
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research/Genetic Susceptibility
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Genetics and Epidemiology
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Genetics and Epidemiology/Genetic Susceptibility
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research/Genetic Susceptibility
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Genetics and Epidemiology
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Genetics and Epidemiology/Genetic Susceptibility
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume20en_US
pubs.embargo.termsNot known
icr.researchteamGenetic Susceptibilityen_US
dc.contributor.icrauthorRahman, Saberaen
dc.contributor.icrauthorMarsden,en


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