Cost-Effectiveness Analysis of Cancer Susceptibility Gene-Specific Prevention and Surveillance Strategies for Ovarian and Breast Cancer

Speaker(s)

Wei X1, Sun L2, Slade E3, Oxley S4, Kalra A4, Sia J4, Sideris M4, Fierheller C4, Brentnall A4, Duffy S4, Evans DG5, Legood R2, Manchanda R4
1Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, LON, UK, 2Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK, 3National Institute for Health and Care Excellence, London, UK, 4Wolfson Institute of Population Health, Queen Mary University of London, London, UK, 5Manchester Centre for Genomic Medicine, Division of Evolution, infection and Genomic Sciences, University of Manchester, Manchester, UK

Presentation Documents

OBJECTIVES: Pathogenic-variants (PVs) in BRCA1/BRCA2/PALB2/RAD51C/RAD51D/BRIP1 cancer-susceptibility-genes (CSGs) confer an increased ovarian cancer (OC) risk, with BRCA1/BRCA2/PALB2/RAD51C/RAD51D PVs also conferring an elevated breast cancer (BC) risk. Risk-reducing surgery, medical prevention, and surveillance offer the opportunity to prevent cancer(s) and death(s), but their cost-effectiveness for the individual CSGs has not been well addressed. We aimed to estimate the cost-effectiveness of prevention strategies for OC and prevention/surveillance strategies for BC risk-reduction for individual BRCA1/BRCA2/PALB2/RAD51C/RAD51D/BRIP1 CSG-carriers.

METHODS: A decision-analytic Markov model evaluated the cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) and where relevant risk-reducing-mastectomy (RRM) at varying ages compared with non-surgical interventions (including BC-surveillance and medical prevention for increased BC-risk) in UK BRCA1/BRCA2/PALB2/RAD51C/RAD51D/BRIP1 PV-carriers. The analysis was conducted from payer perspective, with incremental cost-effectiveness ratio (ICER) calculated as incremental-cost per quality-adjusted life-year (QALY) gained. OC and BC cases and deaths were estimated, with sensitivity and scenario analyses performed.

RESULTS: Combined surgery was optimal for BRCA1 (RRM: 30-years; RRSO: 35-years), BRCA2 (RRM: 35-years; RRSO: 40-years), PALB2 (RRM: 40-years; RRSO: 45-years) PV-carriers, with respective ICERs of £-1,942/QALY, £-89/QALY, £2,381/QALY. RRSO at age 45years was cost-effective for RAD51C/RAD51D/BRIP1 PV-carriers compared with non-surgical intervention strategies, with respective ICERs of £962/QALY, £771/QALY, £2,355/QALY. The optimal strategy could prevent 923 OC and BC cases and 302 deaths, 686 OC and BC cases and 170 deaths, 464 OC and BC cases and 130 deaths, 102 OC-cases and 64 deaths, 118 OC-cases and 76 deaths, and 55 OC-cases and 37 deaths per 1,000 BRCA1/BRCA2/PALB2/RAD51C/RAD51D/BRIP1 PV-carriers respectively. On probabilistic-sensitivity-analysis, RRSO and RRM combined was optimal in 96.5%, 89.2%, 84.8% simulations for BRCA1/BRCA2/PALB2, while RRSO was cost-effective in 100% simulations for RAD51C/RAD51D/BRIP1.

CONCLUSIONS: RRSO with/without RRM at respective optimal ages was cost-effective compared with non-surgical interventions for individual BRCA1/BRCA2/PALB2/RAD51C/RAD51D/BRIP1 PV-carriers. These findings support risk-reducing surgery and guideline recommendations for individual CSG-specific OC and BC-risk management.

Code

EE675

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Genetic, Regenerative & Curative Therapies, Oncology, Personalized & Precision Medicine