Health Economic Evaluation Model for Pancreatic Cancer Risk Management Through Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
Author(s)
Ryutaro Sakai, BS1, Mana AKAI, BS1, Saki Ozeki, BS2, Seiya Taniguchi, BS1, Kensuke Moriwaki, BS, MS, PhD3, Tsuguo Iwatani, MD, PhD4, Nao Suzuki, MD, PhD4.
1Ritsumeikan University, Kusatsu, Japan, 2Ritsumeikan university, Kusatsu, Japan, 3Ritsumeikan University, Kyoto, Japan, 4St. Marianna University School of Medicine, Kawasaki, Japan.
1Ritsumeikan University, Kusatsu, Japan, 2Ritsumeikan university, Kusatsu, Japan, 3Ritsumeikan University, Kyoto, Japan, 4St. Marianna University School of Medicine, Kawasaki, Japan.
OBJECTIVES: In recent years, it has become technically feasible to reduce cancer risk by avoiding BRCA1/2 pathogenic variants through preimplantation genetic testing for monogenic diseases (PGT-M). However, as PGT-M involves selecting embryos, it raises significant ethical, legal, and social concerns that require multifaceted consideration. This study aimed to evaluate the impact of PGT-M on health outcomes, specifically focusing on life expectancy as an indicator of pancreatic cancer risk control.
METHODS: We developed a Markov model comparing offspring born through PGT-M versus natural conception. A 1:1 sex ratio and 50% inheritance rate for BRCA1/2 were assumed. BRCA1/2 carriers had elevated pancreatic cancer risks based on Japanese data (odds ratios: BRCA1 = 12.6, BRCA2 = 10.7). A five-state Markov model (no cancer, localized, regional, distant, death) was used to simulate lifetime outcomes. Sensitivity analyses were performed to assess uncertainty in cancer risk parameters.
RESULTS: Estimated life expectancy was 84.8 years (PGT-M), 83.2 years (BRCA1), and 83.4 years (BRCA2). PGT-M increased life expectancy by 1.42-1.67 years compared to natural conception. Time spent in cancer-related health states decreased (e.g., distant stage reduced by 0.105-0.122 years). Sensitivity analyses showed life-year gains varied from 0.420-4.74 (BRCA1) and 0.630-2.86 (BRCA2) depending on cancer risk assumptions.
CONCLUSIONS: PGT-M improved life expectancy and reduced time in cancer states for BRCA1/2 carriers’ offspring, suggesting enhanced cost-effectiveness in managing hereditary pancreatic cancer risk. Further studies are needed to assess utility weights and healthcare costs specific to Japan to fully evaluate PGT-M’s long-term value.
METHODS: We developed a Markov model comparing offspring born through PGT-M versus natural conception. A 1:1 sex ratio and 50% inheritance rate for BRCA1/2 were assumed. BRCA1/2 carriers had elevated pancreatic cancer risks based on Japanese data (odds ratios: BRCA1 = 12.6, BRCA2 = 10.7). A five-state Markov model (no cancer, localized, regional, distant, death) was used to simulate lifetime outcomes. Sensitivity analyses were performed to assess uncertainty in cancer risk parameters.
RESULTS: Estimated life expectancy was 84.8 years (PGT-M), 83.2 years (BRCA1), and 83.4 years (BRCA2). PGT-M increased life expectancy by 1.42-1.67 years compared to natural conception. Time spent in cancer-related health states decreased (e.g., distant stage reduced by 0.105-0.122 years). Sensitivity analyses showed life-year gains varied from 0.420-4.74 (BRCA1) and 0.630-2.86 (BRCA2) depending on cancer risk assumptions.
CONCLUSIONS: PGT-M improved life expectancy and reduced time in cancer states for BRCA1/2 carriers’ offspring, suggesting enhanced cost-effectiveness in managing hereditary pancreatic cancer risk. Further studies are needed to assess utility weights and healthcare costs specific to Japan to fully evaluate PGT-M’s long-term value.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE491
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology