Lara Petelin1,2, Alison H Trainer3,4, Gillian Mitchell3,4, Danny Liew5,6, Paul A James3,4. 1. Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia. Lara.Petelin@petermac.org. 2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. Lara.Petelin@petermac.org. 3. Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia. 4. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. 5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 6. Department of Medicine, University of Melbourne, Melbourne, Australia.
Abstract
PURPOSE: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. METHODS: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. RESULTS: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. CONCLUSION: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.
PURPOSE: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. METHODS: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. RESULTS: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. CONCLUSION: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.
Authors: Renée L Mulder; Melissa M Hudson; Smita Bhatia; Wendy Landier; Gill Levitt; Louis S Constine; W Hamish Wallace; Flora E van Leeuwen; Cécile M Ronckers; Tara O Henderson; Chaya S Moskowitz; Danielle N Friedman; Andrea K Ng; Helen C Jenkinson; Charlotte Demoor-Goldschmidt; Roderick Skinner; Leontien C M Kremer; Kevin C Oeffinger Journal: J Clin Oncol Date: 2020-09-29 Impact factor: 44.544
Authors: Zoe Kemp; Alice Turnbull; Shawn Yost; Sheila Seal; Shazia Mahamdallie; Emma Poyastro-Pearson; Margaret Warren-Perry; Anthony Eccleston; Min-Min Tan; Soo Hwang Teo; Nicholas Turner; Ann Strydom; Angela George; Nazneen Rahman Journal: JAMA Netw Open Date: 2019-05-03
Authors: Lei Zhang; Yining Bao; Moeen Riaz; Jane Tiller; Danny Liew; Xun Zhuang; David J Amor; Aamira Huq; Lara Petelin; Mark Nelson; Paul A James; Ingrid Winship; John J McNeil; Paul Lacaze Journal: Genet Med Date: 2019-02-18 Impact factor: 8.822