Cost–utility analysis of germline BRCA1/2 testing in women with high‑grade epithelial ovarian cancer in Spain
Keywords: 
Materias Investigacion::Ciencias de la Salud::Oncología
BRCA1 gene
BRCA2 gene
Cancer screening test
Cost–utility analysis
Ovarian cancer
Quality-adjusted life years
Issue Date: 
2019
Publisher: 
Springer Science and Business Media LLC
ISSN: 
1699-048X
Note: 
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Citation: 
Moya‑Alarcón, C. (Carlota); González‑Domínguez, A. (Almudena); Simón, S. (Susana); et al. "Cost–utility analysis of germline BRCA1/2 testing in women with high‑grade epithelial ovarian cancer in Spain". Clinical and Translational Oncology. 21, 2019, 1076 - 1084
Abstract
Purpose: Germline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain. Methods/patients: Incident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value. Results: The BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients' relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost-utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold. Conclusion: Providing this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.

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