Cost–utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain

• Carlota Moya-Alarcón ^[4] ; Almudena González-Domínguez ^[5] ; Susana Simon ^[4] ; Inés Pérez-Román ^[5] ; Antonio González-Martín ^[1] ; Eloisa Bayo-Lozano ^[2] ; Ana Beatriz Sánchez-Heras ^[3]
  1. [1] Clínica Universitaria de Navarra

     Clínica Universitaria de Navarra

     Pamplona, España

     
  2. [2] Hospital Juan Ramón Jiménez

     Hospital Juan Ramón Jiménez

     Huelva, España

     
  3. [3] Hospital General Universitario de Elche

     Hospital General Universitario de Elche

     Elche, España

     
  4. [4] AstraZeneca Farmaceutica España
  5. [5] Weber Madrid

  Mostrar afiliaciones +
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 8 (August), 2019, págs. 1076-1084
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • 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.