Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation

Müller, Dirk; Danner, Marion; Rhiem, Kerstin; Stollenwerk, Björn; Engel, Christoph; Rasche, Linda; Borsi, Lisa; Schmutzler, Rita K.; Stock, Stephanie

doi:10.1007/s10198-017-0887-5

Cited by 33 publications

(52 citation statements)

References 52 publications

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“…This is confirmed by German data [30,31]. From the German Statutory Health Insurance (SHI) perspective, undergoing bilateral mastectomy plus immediate bilateral salpinooophorectomy (BSO) should be recommended to BRCA1 or 2 mutation carriers due to its favorable comparative cost effectiveness.…”

Section: Cost Efficiencymentioning

confidence: 78%

Prophylactic Surgery: For Whom, When and How

Mau

Untch

2017

Breast Care

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Risk-reducing surgery has proved to be a reasonable procedure in healthy women with a definitely elevated risk of developing cancer. Here we consider the elevated risk of breast and ovarian cancer. There is a clear indication for such surgery in healthy women with a pathogenic BRCA1/2 mutation. For these patients, a risk-reducing bilateral mastectomy leads to a verifiable reduction in mortality from breast cancer, particularly for young patients. In most cases, surgery is combined with breast reconstruction. The pros and cons of surgical treatment and the different surgical techniques have to be explained to and carefully considered with the patient. As yet, no unequivocal data for the benefits of intensifying early detection have been ascertained with respect to mortality from breast carcinoma. In index patients with a BRCA mutation, the surgical treatment should depend on the prognosis of the primary disease. A lower age at onset and a better prognosis of the primary disease make a contralateral mastectomy (CPM) more reasonable. In the case of BRCA mutation-related cancer, a reduction of mortality through CPM has been proven. A risk-reducing adnexectomy is basically recommended for BRCA mutation carriers. Healthy premenopausal women need a subsequent hormone replacement therapy. The prognosis of the patients is dominated by the ovarian carcinoma. This can be prevented by risk-reducing salpingo-oophorectomy in 95% of the cases.

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Section: Cost Efficiencymentioning

confidence: 78%

Prophylactic Surgery: For Whom, When and How

Mau

Untch

2017

Breast Care

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“…Four additional references were added from an updated literature search performed on 21 July 2017. [21][22][23][24] Description of studies: key characteristics Eligible studies consisted of 8 comparative effectiveness analyses (CEs) and 26 economic evaluations (EEs), including five government-sponsored health technology assessments. Key characteristics are reported in Table 1 and Supplementary Table S3.…”

Section: Study Selectionmentioning

confidence: 99%

“…Target populations were exclusively female. From the EEs, 12/26 assessed the cost-effectiveness of breast cancer screening, 6,22,26,32,37,40,41,44,45,[47][48][49] 2/26 prophylactic surgery, 50,51 4/26 a combination of risk management interventions, 23,24,27,39 and the remaining 8/26 were evaluations of genetic testing or cancer genetics services. 21,[28][29][30]33,43,46,52 Risk-reducing medication was considered in only 4/34 studies.…”

Section: Study Selectionmentioning

confidence: 99%

“…The viewpoint of the analysis was not expressly stated in 9/26 of EEs, although could usually be inferred from the description of costs included. 26,27,33,40,43,46,47,52,53 Other areas that were inadequately reported were details of price adjustments to account for inflation or currency conversion (15/26), [21][22][23]29,30,32,33,39,41,44,45,47,49,50,53 and justification for the specific costs included in studies that measured productivity changes such as lost wages (2/6). 32,51 Model inputs for cancer penetrance, mortality, and the clinical effectiveness of interventions were clearly stated.…”

Section: Study Selectionmentioning

confidence: 99%

“…For studies using multiple sources, the method of selection and synthesis of effectiveness estimates were often poorly reported or unclear (10/15). 23,26,27,32,33,37,40,44,50,52 Sensitivity analyses were of mixed quality; a probabilistic sensitivity analysis was performed in 11/34 studies, 21,23,24,27,28,40,[43][44][45]48,49 and 13/34 reported a more limited one-way sensitivity analysis only. 22,30,31,33,35,37,39,41,46,47,51,52,54 BRCA-specific cancer survival was included in 12/34 studies.…”

Section: Study Selectionmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers: a systematic review

Petelin

Trainer

Liew

et al. 2018

Genetics in Medicine

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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.

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Cost‐effectiveness of risk‐based breast cancer screening: A systematic review

Khan

Hernandez-Villafuerte

Muchadeyi

et al. 2021

Intl Journal of Cancer

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To analyse published evidence on the economic evaluation of risk‐based screening (RBS), a full systematic literature review was conducted. After a quality appraisal, we compared the cost‐effectiveness of risk‐based strategies (low‐risk, medium‐risk and high‐risk) with no screening and age‐based screening. Studies were also analysed for modelling, risk stratification methods, input parameters, data sources and harms and benefits. The 10 modelling papers analysed were based on screening performance of film‐based mammography (FBM) (three); digital mammography (DM) and FBM (two); DM alone (three); DM, ultrasound (US) and magnetic resonance imaging (one) and DM and US (one). Seven studies did not include the cost of risk‐stratification, and one did not consider the cost of diagnosis. Disutility was incorporated in only six studies (one for screening and five for diagnosis). None of the studies reported disutility of risk‐stratification (being considered as high‐risk). Risk‐stratification methods varied from only breast density (BD) to the combination of familial risk, genetic susceptibility, lifestyle, previous biopsies, Jewish ancestry and reproductive history. Less or no screening in low‐risk women and more frequent mammography screening in high‐risk women was more cost‐effective compared to no screening and age‐based screening. High‐risk women screened annually yielded a higher mortality rate reduction and more quality‐adjusted life years at the expense of higher cost and false positives. RBS can be cost effective compared to the alternatives. However, heterogeneity among risk‐stratification methods, input parameters, and weaknesses in the methodologies hinder the derivation of robust conclusions. Therefore, further studies are warranted to assess newer technologies and innovative risk‐stratification methods.

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Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation

Abstract: From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.

Cited by 33 publications

References 52 publications

Prophylactic Surgery: For Whom, When and How

Prophylactic Surgery: For Whom, When and How

Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers: a systematic review

Cost‐effectiveness of risk‐based breast cancer screening: A systematic review

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