Economic Modelling of Screen-and-Treat Strategies for Brazilian Women at Risk of Hereditary Breast and Ovarian Cancer

Abstract

Background Clinical evidence supports the use of genetic counselling and BRCA1/2 testing for women at risk for hereditary breast and ovarian cancer. Currently, screen-and-treat strategies are not reimbursed in the Brazilian Unified Healthcare System (SUS). The aim of this modelling study was to evaluate the cost effectiveness of a gene-based screen-and-treat strategy for BRCA1/2 in women with a high familial risk followed by preventive interventions compared with no screening. Methods Adopting the SUS perspective, a Markov model with a lifelong time horizon was developed for a cohort of healthy women aged 30 years that fulfilled the criteria for BRCA1/2 testing according to the National Comprehensive Cancer Network (NCCN) guideline. For women who tested positive, preventive options included intensified surveillance, risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. The Markov model comprised the health states 'well', 'breast cancer', 'death' and two post-cancer states. Outcomes were the incremental costs per quality-adjusted life-year (QALY) and the incremental costs per life-year gained (LYG). Data were mainly obtained by a literature review. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results. Results In the base case, the screen-and-treat strategy resulted in additional costs of 3515 Brazilian reais

Data on Utility in Cost–Utility Analyses of Genetic Screen-and-Treat Strategies for Breast and Ovarian Cancer

“…Table 2 summarizes the application of utility for the selected studies. For all models except four [ 18 , 19 , 20 , 21 ], an adjustment for both age and target population was made. For combining data on utility, in six modeling studies the authors declared to have used the multiplicative method [ 18 , 19 , 22 , 23 , 24 , 25 ], while the remaining studies did not report the method.…”

Gastos Do Sistema Público De Saúde Com Tratamento Em Oncologia

“…Por esse motivo, a estimativa de custo do câncer neste estudo é considerada conservadora (SIQUEIRA et al, 2017). De acordo com o Banco Mundial, em 2010 os custos com saúde representaram 17,02% nos EUA, 10,2% na UE, 9,51% no Reino Unido, 8,27% no Brasil e 6,79% na Coreia do Sul (CORREA-GALENDI et al, 2020). A razão custo-efetividade calculada no estudo de Correa-Galendi et al (2020) chegou à conclusão de que está abaixo do limite de custo-efetividade proposto pela Organização Mundial da Saúde (OMS) recomendado para países de renda média (ou seja, 1 a 3 do PIB per capita).…”

The role of genomics in global cancer prevention

“…Two studies have examined the cost effectiveness of genetic testing for hereditary breast and ovarian cancer patients with SUS coverage, and propose that inclusion of this technology in this health care system is justified. In 2020, Simoes Correa-Galendi et al 169 reported that the incremental cost-effectiveness ratio for testing at-risk patients for BRCA1/2 mutations, calculated from the SUS perspective, is close to the cost-effectiveness threshold proposed by the WHO for lower middle-income countries (LMICs). Before this publication, Ramos et al 170 showed that genetic testing for BRCA1/2 in high-risk patients with SUS coverage was cost effective when genetic testing was expanded and prophylactic measures were adopted for family members (cascade testing).…”