Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers

a systematic review

Lara Petelin, Alison H. Trainer, Gillian Mitchell, Danny Liew, Paul A. James

Research output: Contribution to journalReview ArticleResearchpeer-review

4 Citations (Scopus)

Abstract

Purpose: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. Methods: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. Results: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. Conclusion: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.

Original languageEnglish
Pages (from-to)1145-1156
Number of pages12
JournalGenetics in Medicine
Volume20
Issue number10
DOIs
Publication statusPublished - 1 Oct 2018

Cite this

Petelin, Lara ; Trainer, Alison H. ; Mitchell, Gillian ; Liew, Danny ; James, Paul A. / Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers : a systematic review. In: Genetics in Medicine. 2018 ; Vol. 20, No. 10. pp. 1145-1156.
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abstract = "Purpose: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. Methods: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. Results: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100{\%} adherence. Conclusion: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.",
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Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers : a systematic review. / Petelin, Lara; Trainer, Alison H.; Mitchell, Gillian; Liew, Danny; James, Paul A.

In: Genetics in Medicine, Vol. 20, No. 10, 01.10.2018, p. 1145-1156.

Research output: Contribution to journalReview ArticleResearchpeer-review

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T1 - Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers

T2 - a systematic review

AU - Petelin, Lara

AU - Trainer, Alison H.

AU - Mitchell, Gillian

AU - Liew, Danny

AU - James, Paul A.

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N2 - Purpose: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. Methods: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. Results: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. Conclusion: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.

AB - Purpose: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. Methods: Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. Results: Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. Conclusion: Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.

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