Carlota Moya-Alarcón1, Almudena González-Domínguez2, Susana Simon1, Inés Pérez-Román3, Antonio González-Martín4,5, Eloisa Bayo-Lozano6, Ana Beatriz Sánchez-Heras5,7. 1. AstraZeneca Farmaceutica Spain, 56, Serrano Galvache Street, Building Álamo, 28033, Madrid, Spain. 2. Weber, 17, 5º, Moreto Street, 28014, Madrid, Spain. almudena.gonzalez@weber.org.es. 3. Weber, 17, 5º, Moreto Street, 28014, Madrid, Spain. 4. Clínica Universidad de Navarra, 1, Marquesado de Santa Marta Street, 28027, Madrid, Spain. 5. Grupo Español de Investigación en Cáncer de Ovario (GEICO), 151, Santa Engracia Street, Floor 5, Office 3, 28003, Madrid, Spain. 6. Plan Integral de Oncología de Andalucía, Servicio Andaluz de Salud, Hospital Juan Ramón Jiménez, Ronda Exterior Norte, 21005, Huelva, Spain. 7. Unidad de Consejo Genético en Cáncer, Hospital General Universitario de Elche, 11, Camino de la Almazara, 03203, Elche, Spain.
Abstract
PURPOSE: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. METHODS/PATIENTS: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. RESULTS: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. CONCLUSION: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.
PURPOSE: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. METHODS/PATIENTS: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. RESULTS: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. CONCLUSION: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.
Entities:
Keywords:
BRCA1 gene; BRCA2 gene; Cancer screening test; Cost–utility analysis; Ovarian cancer; Quality-adjusted life years
Authors: Panagiotis A Konstantinopoulos; Barbara Norquist; Christina Lacchetti; Deborah Armstrong; Rachel N Grisham; Paul J Goodfellow; Elise C Kohn; Douglas A Levine; Joyce F Liu; Karen H Lu; Dorinda Sparacio; Christina M Annunziata Journal: J Clin Oncol Date: 2020-01-27 Impact factor: 44.544