Cost Effectiveness of Mastectomies of BRCA1 and BRCA2 Positive Women over Olaparib

OBJECTIVES: Breast cancer is the most common type of cancer in women in the United States. Approximately 1 in every 500 women will have a mutation on their BRCA1/2 gene, making the risk of developing breast cancer even higher. Prophylactic mastectomies are used to prevent cancer before it develops. Olaparib is a first-line, targeted therapy for patients with BRCA gene-mutated breast cancer. With limited economic evaluations between these two therapies, the objective of this study was to determine the cost-effectiveness of having a prophylactic mastectomy after finding the BRCA gene mutation or waiting until the development of breast cancer and being treated with guideline-directed therapy such as olaparib.

METHODS: We performed a literature review using PubMed articles from 2010-2023, which reported the cost and life expectancies/mortality benefits of each treatment type. We found the cost of having a prophylactic bilateral mastectomy and the cost of therapy with olaparib after the development of breast cancer and averaging those costs over a QALYs expectancy of 13.8 months. We then compared total and indirect costs with QALYs to determine each therapy’s cost-effectiveness.

RESULTS: A bilateral mastectomy with DEIP reconstructions and olaparib increases QALYs by approximately 17.53 years, costing roughly $94,733, and by 1.15 years, costing nearly $14,523 monthly, respectively. Based on the average treatment time, if patients continue olaparib throughout their treatment processes, their estimated total cost would be $200,417.40. Adverse effect treatments from olaparib and mammaplasty from a mastectomy have indirect costs approaching $5,595 and $4,294, respectively.

CONCLUSIONS: The cumulative indirect and direct cost of mastectomies is approximately $99,027; comparatively, olaparib treatment is essentially $206,012.40. With mastectomies regularly occurring proactively and BRCA+ patients having a 45-85% chance of developing breast cancer in their lifetime, a mastectomy seems to be more cost-effective overall than olaparib treatment.