Development of a Discrete Event Simulation Model to Explore the Potential Cost-Effectiveness for Cancer Early Detection Testing in Female BRCA Carriers
Author(s)
Lucas F. van Schaik, MSc, PharmD1, Astrid Kramer, PhD2, Marjanka Schmidt, PhD3, Wim van Harten, MD PhD3, Valesca P. Retel, MSc, PhD4.
1PhD-Student, Netherlands Cancer Institute (NKI-AVL), Utrecht, Netherlands, 2Netherlands Cancer Institute, Ilpendam, Netherlands, 3Netherlands Cancer Institute, Amsterdam, Netherlands, 4Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands.
1PhD-Student, Netherlands Cancer Institute (NKI-AVL), Utrecht, Netherlands, 2Netherlands Cancer Institute, Ilpendam, Netherlands, 3Netherlands Cancer Institute, Amsterdam, Netherlands, 4Netherlands Cancer Institute (NKI-AVL), Amsterdam, Netherlands.
OBJECTIVES: Women with pathogenic BRCA1 or BRCA2 gene alterations have a lifetime risk of ovarian cancer between 20-60%. Currently, women are advised to undergo risk-reducing salpingo-oophorectomy (RRSO) at early age, inducing early menopause. An effective screening program could support shared decision-making, enabling young women to make choices in ovarian cancer risk management that align with their life stage and personal preferences. This study aims to develop a model that explores the conditions under which liquid biopsies could be a cost-effective method for ovarian cancer screening in BRCA1/2 carriers.
METHODS: A discrete event simulation model was developed in R to compare current RRSO strategy with a shared decision-making strategy with liquid biopsy screening delaying the invasive RRSO procedure. Participant characteristics were sampled from the nationwide Dutch HEBON (Hereditary Breast and Ovarian cancer Netherlands) cohort. Personalised ovarian and breast cancer risks were estimated by applying the validated BOADICEA risk prediction model to HEBON participant characteristics. Survival after diagnosis was estimated utilising Dutch nation-wide cancer registry stage-specific relative survival.
RESULTS: The model structure consisted of three components, utilising a tumour stage-shift mechanism to incorporate screening effects. First was the natural disease history component modelling natural history of breast and ovary cancer development in absence of screening. Tumour growth was estimated using individualised tumour volume doubling time. Second, the screening component, which imposed a screening program and preventive procedures onto the natural history component. Third, the service pathway component, assigning cancer stage and determining stage-specific survival, quality-of-life, and healthcare costs. The developed model allows for estimating the cost-effectiveness at varying test characteristics and preferences of women regarding the timing of RRSO and survival.
CONCLUSIONS: Results from our model will be able to set the conditions under which liquid biopsy based screening would be optimal in a high risk population and help steer further research on ovarian cancer screening.
METHODS: A discrete event simulation model was developed in R to compare current RRSO strategy with a shared decision-making strategy with liquid biopsy screening delaying the invasive RRSO procedure. Participant characteristics were sampled from the nationwide Dutch HEBON (Hereditary Breast and Ovarian cancer Netherlands) cohort. Personalised ovarian and breast cancer risks were estimated by applying the validated BOADICEA risk prediction model to HEBON participant characteristics. Survival after diagnosis was estimated utilising Dutch nation-wide cancer registry stage-specific relative survival.
RESULTS: The model structure consisted of three components, utilising a tumour stage-shift mechanism to incorporate screening effects. First was the natural disease history component modelling natural history of breast and ovary cancer development in absence of screening. Tumour growth was estimated using individualised tumour volume doubling time. Second, the screening component, which imposed a screening program and preventive procedures onto the natural history component. Third, the service pathway component, assigning cancer stage and determining stage-specific survival, quality-of-life, and healthcare costs. The developed model allows for estimating the cost-effectiveness at varying test characteristics and preferences of women regarding the timing of RRSO and survival.
CONCLUSIONS: Results from our model will be able to set the conditions under which liquid biopsy based screening would be optimal in a high risk population and help steer further research on ovarian cancer screening.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE327
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology