A cost-minimization analysis of a preventive testing strategy for relatives of patients with BRCA mutated ovarian cancer
Keywords:Costs, Healthcare expenditure, Ovarian cancer, Test BRCA
Purpose: This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia.
Methods: A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed.
Results: Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed.
Conclusions: Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values.
I numeri del cancro in Italia – 2016, Associazione Italiana Registri Tumori (AIRTUM).
Linee Guida Tumori dell’Ovaio, Edizione 2016, Associazione Italiana di Oncologia Medica.
Alsop K, Fereday S, Meldrum C et al. BRCA mutation frequency and patterns of treatment response in BRCA mutation-positive women with ovarian cancer: a report from the Australian Ovarian Cancer Study Group. J Clin Oncol. 2012 Jul 20;30(21):2654-63.
Schrader KA, Hurlburt J, Kalloger SE et al. Germline BRCA1 and BRCA2 mutations in ovarian cancer: utility of a histology-based referral strategy. Obstet Gynecol. 2012 Aug;120(2 Pt 1):235-40.
Pennington KP, Walsh T, Harrell MI et al. Germline and somatic mutations in homologous recombination genes predict platinum response and survival in ovarian, fallopian tube, and peritoneal carcinomas. Clin Cancer Res. 2014 Feb 1;20(3):764-75.
Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst. 2009;101(2):80-7.
Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol. 2007 Apr 10;25(11):1329-33.
Bolton KL, Chenevix-Trench G, Goh C et al; EMBRACE; kConFab Investigators; Cancer Genome Atlas Research Network. Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer. JAMA. 2012 Jan 25;307(4):382-90.
Safra T, Rogowski O, Muggia FM. The effect of germ-line BRCA mutations on response to chemotherapy and outcome of recurrent ovarian cancer. Int J Gynecol Cancer. 2014 Mar;24(3):488-95.
Ledermann J, Harter P, Gourley C et al. Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer. N Engl J Med. 2012;366:1382-92.
Raccomandazioni per l’implementazione del test BRCA nei percorsi assistenziali e terapeutici delle pazienti con carcinoma ovarico. A cura del Gruppo di Lavoro AIOM - SIGU - SIBIOC - SIAPEC-IAP.
Manchanda R, Legood R, Burnell M et al. Cost-effectiveness of population screening for BRCA mutations in Ashkenazi jewish women compared with family history-based testing. J Natl Cancer Inst. 2014 Nov 30;107(1):380.
Ahmad AS, Ormiston-Smith N, Sasieni PD. Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960. Br J Cancer. 2015 Mar 3;112(5):943-7.
Evans DG, Lalloo F, Ashcroft L et al. Uptake of risk-reducing surgery in unaffected women at high risk of breast and ovarian cancer is risk, age, and time dependent. Cancer Epidemiol Biomarkers Prev. 2009;18(8):2318-24.
Manchanda R, Burnell M, Abdelraheim A et al. Factors influencing uptake and timing of risk-reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG. 2012;119(5):527-36.
Nomenclatore tariffario ospedaliero Regione Lombardia.
Nomenclatore tariffario dell’assistenza specialistica ambulatoriale Ministero della Salute.
Gazzetta Ufficiale – Serie generale n. 23 del 28.1.2013 – Supplemento Ordinario n. 8, Decreto 18 ottobre 2012 Ministero della salute.
Allegato A al Decreto n. 119 del 12 maggio 2015, Regione del Veneto, Area Sanità e Sociale, Raccomandazioni Evidence Based, Bevacizumab - Avastin®.
Allegato A al Decreto n. 119 del 12 maggio 2015, Regione del Veneto, Area Sanità e Sociale, Raccomandazioni Evidence Based, Pertuzumab - Perjeta®.
Coordinamento Regionale Unico sul Farmaco, BEVACIZUMAB per l’indicazione: trattamento in prima linea di pazienti con carcinoma mammario metastatico in combinazione con paclitaxel. (09-09-2008), Regione Veneto.
Coordinamento Regionale Unico sul Farmaco, FULVESTRANT (13-09-2005), Regione Veneto.
Coordinamento Regionale Unico sul Farmaco, paclitaxel albumina - ABAXTRANE, Regione Veneto.
Eccleston A, Bentley A, Dyer M et al. Cost-effectiveness evaluation of germline BRCA1 and BRCA2 testing in UK women with ovarian cancer. Value Health. 2017 Apr;20(4):567-76.
Zeichner SB, Stanislaw C, Meisel JL. Prevention and screening in hereditary breast and ovarian cancer. Oncology (Williston Park). 2016 Oct 15;30(10):896-904.
Cicchetti A, Ruggeri M, Di Brino E. Cost-effectiveness of a preventive testing strategy in relatives of patients with BRCA mutated ovarian cancer versus a no test strategy. Value in Health, Volume 19, Issue 7, A696.
Kwon JS, Gutierrez-Barrera AM, Young D et al. Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol. 2010 Sep 20;28(27):4214-20.
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