Economic Evaluation of Using a Genetic Test to Direct Breast Cancer Chemoprevention in White Women with a Previous Breast Biopsy

Abstract

From the US payer's perspective, the combined genetic and clinical risk assessment strategy may be a moderately cost-effective alternative to using clinical risk alone to guide chemoprevention recommendations for women at intermediate risk of developing breast cancer.

Use and Applicability of the Gail Model to Calculate Breast Cancer Risk: A Scoping Review

“…The Gail model has been used to determine the clinical indication of chemoprevention based on the eligibility of women according to their breast cancer risk (Pruthy et al, 2015;Reimers et al, 2015;Vanegas et al, 2018;Green et al, 2014;Oseni et al, 2016). In turn, Pederson et al (2018) compared the use of the Gail model and the Tyrer-Cuzick model to determine the risk of breast cancer and the implications for chemoprevention.…”

“…Although the Gail model is discussed regarding its real-world applicability, our findings indicate a lack of studies on this topic. Some of the reviewed studies showed that certain countries still use the tool in clinical settings to determine the eligibility of women for chemoprevention, namely, Pruthi et al, (2015), Reimers et al, (2015), Vanegas et al, (2018), Green et al, (2014), andOseni et al, (2016). Despite the limitations of the Gail model in some populations due to local risk factors, this tool is indicated by the United States Preventive Services Task Force to determine the eligibility of women for chemoprevention.…”

Cost-effectiveness of precision medicine: a scoping review

“…A higher probability of complications (including mortality) will decrease the cost-effectiveness of a PM intervention (Alagoz et al 2016; Chong et al 2014; Gonzalez et al 2015; Jahn et al 2015, 2017; Ke et al 2017; Moretti et al 2017; Pink et al 2014; Plumpton et al 2015; Saokaew et al 2014; Schremser et al 2015; Snowsill et al 2017) by decreasing the number of life years gained. For the same reason, factors such as age at testing (Buchanan et al 2017; Green et al 2014; Jahn et al 2015; Manchanda et al 2015), as well as the stage of the disease (Schremser et al 2015), will have the same effect. A person with end-stage metastatic cancer might still benefit from a PM intervention, but the cost-effectiveness ratio will be much lower, as the potential benefit is smaller.…”

“…Another factor identified in our review as a barrier to cost-effectiveness of PM interventions is the high cost of some genetic tests (Ademi et al 2017; Alagoz et al 2016; Chong et al 2014; Green et al 2014; Grosse 2015; Martes-Martinez et al 2017; Naylor et al 2014; Nguyen et al 2017; Plothner et al 2016; Rubio-Terres et al 2015; Wang et al 2017). However, it has been observed that the cost of genetic testing has been decreasing and is expected to continue to do so in the future (National Institute of Health NIH 2016).…”

“…Finally, factors such as the health-related quality of life (HRQoL) during and after a preventive treatment, the timeframe when a risk factor was identified, patient adherence to treatment, the uptake of genetic testing in situations of hereditary risk factors and the impact of genetic testing on HRQoL were also identified as having a potential impact on the cost-effectiveness of PM (Balentine et al 2017; Green et al 2014; Martes-Martinez et al 2017; Plothner et al 2016; Shiffman et al 2015; Snowsill et al 2017; Verhoef et al 2016). Most of these factors have been previously identified, and our findings reinforce results from previous reviews (Beaulieu et al 2010; Berm et al 2016; Ferrusi et al 2009; Goldie and Levin 2001; Husereau et al 2014; Institute of Medicine 2013; Veenstra et al 2000).…”