Treatment of Early-Stage Breast Cancer in the Elderly

Carter, Kimbroe J.; Ritchey, Nathan P.; Castro, Frank; Caccamo, Leonard P.; Kessler, E; Erickson, Barbara A.; Gawdyda, Lori

doi:10.1177/0272989x9801800210

Cited by 44 publications

(14 citation statements)

References 32 publications

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“…The value of h = 0.83 is consistent with TTO and SG values reported in several studies exploring health utilities of breast and colon cancer patients. These health estimates range from h = 0.80 to h = 0.88 (see Grann et al, 1998;Carter et al, 1998;Gerard et al, 1993;Launois et al, 1996;Jansen et al, 1998;Smith et al, 1993). Recall that 1/a is the minimal consumption level required for existence.…”

Section: Resultsmentioning

confidence: 99%

The utility of health and wealth

Levy

Nir

2012

Journal of Health Economics

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Section: Resultsmentioning

confidence: 99%

The utility of health and wealth

Levy

Nir

2012

Journal of Health Economics

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“…Quality-of-life weights (utilities) were applied to noncancer states 13 and to other health states in the model (prophylactic surgery, endometrial cancer, ovarian cancer). [14][15][16][17][18][19][20][21][22] With an average utility of 0.86 for prophylactic surgery, 1 year is quality-adjusted to an equivalent of 0.86 years without this intervention (because of loss of fertility and other effects of premature menopause). This adjustment is carried through until age 45 years, when quality of life begins to decline among women in the general population.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome

Kwon

Sun

Peterson

et al. 2008

Cancer

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BACKGROUND. Women with Lynch syndrome (hereditary nonpolyposis colorectal cancer) have an increased lifetime risk for endometrial and ovarian cancer. Screening and prophylactic surgery have been recommended as prevention strategies. In this study, the authors estimated the net health benefits and cost‐effectiveness of these strategies in a Markov decision‐analytic model. METHODS. Five strategies were compared for a hypothetical cohort of women with Lynch syndrome: 1) no prevention (‘reference’); 2) prophylactic surgery (hysterectomy and bilateral salpingo‐oophorectomy) at age 30 years; 3) prophylactic surgery at age 40 years; 4) annual screening with endometrial biopsy, transvaginal ultrasound, and CA 125 from age 30 years; and 5) annual screening from age 30 years until prophylactic surgery at age 40 years (combined strategy). Net health benefit was measured in quality‐adjusted life years (QALYs), and the primary outcome measured was the incremental cost‐effectiveness ratio (ICER). Baseline and transition probabilities were obtained from published literature, and costs were from the U.S. Department of Health and Human Services and Agency for Health Care Quality and Research. Sensitivity analyses were performed for uncertainty around various parameters. RESULTS. The combined strategy provided the highest net health benefit (18.98 QALYs) but had an ICER of $194,650 per QALY relative to the next best strategy (prophylactic surgery at age 40 years). Prophylactic surgery at age 30 years and annual screening were dominated by alternate strategies. CONCLUSIONS. Annual screening followed by prophylactic surgery at age 40 years was the most effective gynecologic cancer prevention strategy, but the incremental benefit over prophylactic surgery alone was attained at substantial cost. The ICER would become favorable by improving the effectiveness and reducing the costs of screening in this population. Cancer 2008. © 2008 American Cancer Society.

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“…[203][204][205][206][207] Unfortunately, the authors provide no detail as to how they derived their estimate from these sources. In their cost-effectiveness models, both Dinh and colleagues (2011) 55 and Yang and colleagues (2011) 76 also assume a utility of 0.83 for women with EC, both citing Kwon (2008).…”

Section: Assessment Of Cost-effectiveness: Description Of the Economimentioning

confidence: 99%

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

108

234

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BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Treatment of Early-Stage Breast Cancer in the Elderly

Abstract: Although the model showed little difference between QALYs with the treatments, the combination of radiation and tamoxifen provides the optimal therapy for this case.

Cited by 44 publications

References 32 publications

The utility of health and wealth

The utility of health and wealth

Cost‐effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

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