Universität zu Köln

Mueller, Dirk, Danner, Marion ORCID: 0000-0002-0653-4092, Schmutzler, Rita ORCID: 0000-0001-8160-4348, Engel, Christoph ORCID: 0000-0002-7247-282X, Wassermann, Kirsten, Stollenwerk, Björn ORCID: 0000-0002-3189-409X, Stock, Stephanie ORCID: 0000-0002-1726-9300 and Rhiem, Kerstin (2019). Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer. Eur. J. Health Econ., 20 (5). S. 739 - 751. NEW YORK: SPRINGER. ISSN 1618-7601

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Abstract

Background The 'German Consortium for Hereditary Breast and Ovarian Cancer' (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test. Methods A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of >= 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states 'well' (women with increased risk), 'breast cancer without metastases', 'breast cancer with metastases', 'ovarian cancer', 'death', and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC. Results Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of (sic)7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of (sic)17,027 per QALY; cost per LYG: (sic)22,318). The results were robust in deterministic and probabilistic sensitivity analyses. Conclusion The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of >= 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mueller, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Danner, Marion UNSPECIFIED orcid.org/0000-0002-0653-4092 UNSPECIFIED Schmutzler, Rita UNSPECIFIED orcid.org/0000-0001-8160-4348 UNSPECIFIED Engel, Christoph UNSPECIFIED orcid.org/0000-0002-7247-282X UNSPECIFIED Wassermann, Kirsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Stollenwerk, Björn UNSPECIFIED orcid.org/0000-0002-3189-409X UNSPECIFIED Stock, Stephanie UNSPECIFIED orcid.org/0000-0002-1726-9300 UNSPECIFIED Rhiem, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-136345
DOI:	10.1007/s10198-019-01038-1
Journal or Publication Title:	Eur. J. Health Econ.
Volume:	20
Number:	5
Page Range:	S. 739 - 751
Date:	2019
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1618-7601
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Sonstiges > Zentrum für Versorgungsforschung Köln
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language BRCA2 MUTATION CARRIERS; STATE UTILITY VALUES; HEREDITARY BREAST; PROPHYLACTIC MASTECTOMY; COST-EFFECTIVENESS; PSYCHOLOGICAL DISTRESS; REDUCING SURGERIES; HER2 STATUS; IMPACT; ASSOCIATION Multiple languages Economics; Health Policy & Services Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13634