Universität zu Köln

Mueller, Dirk, Danner, Marion ORCID: 0000-0002-0653-4092, Rhiem, Kerstin, Stollenwerk, Björn ORCID: 0000-0002-3189-409X, Engel, Christoph ORCID: 0000-0002-7247-282X, Rasche, Linda, Borsi, Lisa, Schmutzler, Rita K. ORCID: 0000-0001-8160-4348 and Stock, Stephanie ORCID: 0000-0002-1726-9300 (2018). Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation. Eur. J. Health Econ., 19 (3). S. 341 - 354. NEW YORK: SPRINGER. ISSN 1618-7601

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Abstract

Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation. A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed. With costs of a,notsign29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 a,notsign per QALY, the probability of the intervention being cost-effective was 80%. From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.

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 Rhiem, Kerstin UNSPECIFIED UNSPECIFIED UNSPECIFIED Stollenwerk, Björn UNSPECIFIED orcid.org/0000-0002-3189-409X UNSPECIFIED Engel, Christoph UNSPECIFIED orcid.org/0000-0002-7247-282X UNSPECIFIED Rasche, Linda UNSPECIFIED UNSPECIFIED UNSPECIFIED Borsi, Lisa UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmutzler, Rita K. UNSPECIFIED orcid.org/0000-0001-8160-4348 UNSPECIFIED Stock, Stephanie UNSPECIFIED orcid.org/0000-0002-1726-9300 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-191829
DOI:	10.1007/s10198-017-0887-5
Journal or Publication Title:	Eur. J. Health Econ.
Volume:	19
Number:	3
Page Range:	S. 341 - 354
Date:	2018
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 STATE UTILITY VALUES; PROPHYLACTIC MASTECTOMY; ECONOMIC BURDEN; UNITED-STATES; HER2 STATUS; CARRIERS; RISK; OOPHORECTOMY; MANAGEMENT; MORTALITY Multiple languages Economics; Health Policy & Services Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19182