Health Economic Evaluation Model for Prostate Cancer Risk Management Through Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)
Author(s)
Seiya Taniguchi, BS1, Mana AKAI, BS2, Saki Ozeki, BS3, Ryutaro Sakai, BS2, Kensuke Moriwaki, BS, MS, PhD4, Tsuguo Iwatani, MD, PhD5, Nao Suzuki, MD, PhD6.
1Student, Ritsumeikan University, Kusatsu, Japan, 2Ritsumeikan University, Kusatsu, Japan, 3Ritsumeikan university, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan, 5Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan, 6Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
1Student, Ritsumeikan University, Kusatsu, Japan, 2Ritsumeikan University, Kusatsu, Japan, 3Ritsumeikan university, Kusatsu, Japan, 4Ritsumeikan University, Kyoto, Japan, 5Department of Breast and Endocrine Surgery, St. Marianna University School of Medicine, Kanagawa, Japan, 6Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan.
OBJECTIVES: Carriers of BRCA1/2 pathogenic variants face significantly elevated cancer risks, including prostate cancer. Since these variants are inherited in an autosomal dominant manner, there is a 50% chance of transmission to offspring. Preimplantation genetic testing for monogenic disorders (PGT-M), a technique combined with in vitro fertilization (IVF), can prevent transmission by selecting embryos without pathogenic variants. While PGT-M is technically feasible, its ethical, legal and social Issues implications limit its use. The aim of this study is to evaluate the impact of PGT-M on the control of prostate cancer risk in BRCA1/2 mutation carriers, using a model tailored to the Japanese healthcare context.
METHODS: A Markov model was developed to estimate the long-term outcomes of couples in which either partner carries a BRCA1/2 mutation, comparing two groups: natural conception group (50% chance of BRCA1/2 mutation) and PGT-M group (no mutation). The model included five health states: event-free, localized cancer, regional cancer, distant cancer, and death. The impact of BRCA1/2 mutations was incorporated by adjusting cancer incidence using odds ratios (ORs) derived from Japanese epidemiological data (OR: 1.1 for BRCA1 and 4.0 for BRCA2). Life years were estimated for each group.
RESULTS: Expected LYs were 81.998 (BRCA1), 81.916 (BRCA2), and 82.001 (PGT-M). While the gain in overall survival from PGT-M was limited (ΔLY: +0.003 to +0.085), the time spent in prostate cancer states was reduced (ΔLY: −1.613 to −0.062).
CONCLUSIONS: Although the impact of PGT-M on overall survival is limited, its reduction of time spent in prostate cancer states suggests potential improvements in quality-adjusted life years (QALYs). To evaluate long-term cost-effectiveness from the perspective of Japan's public healthcare system, further analysis is warranted using utility values specific to the Japanese population and patterns of healthcare resource use under the Japanese healthcare system.
METHODS: A Markov model was developed to estimate the long-term outcomes of couples in which either partner carries a BRCA1/2 mutation, comparing two groups: natural conception group (50% chance of BRCA1/2 mutation) and PGT-M group (no mutation). The model included five health states: event-free, localized cancer, regional cancer, distant cancer, and death. The impact of BRCA1/2 mutations was incorporated by adjusting cancer incidence using odds ratios (ORs) derived from Japanese epidemiological data (OR: 1.1 for BRCA1 and 4.0 for BRCA2). Life years were estimated for each group.
RESULTS: Expected LYs were 81.998 (BRCA1), 81.916 (BRCA2), and 82.001 (PGT-M). While the gain in overall survival from PGT-M was limited (ΔLY: +0.003 to +0.085), the time spent in prostate cancer states was reduced (ΔLY: −1.613 to −0.062).
CONCLUSIONS: Although the impact of PGT-M on overall survival is limited, its reduction of time spent in prostate cancer states suggests potential improvements in quality-adjusted life years (QALYs). To evaluate long-term cost-effectiveness from the perspective of Japan's public healthcare system, further analysis is warranted using utility values specific to the Japanese population and patterns of healthcare resource use under the Japanese healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE492
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology