期刊
GENETICS IN MEDICINE
卷 22, 期 5, 页码 831-839出版社
ELSEVIER SCIENCE INC
DOI: 10.1038/s41436-020-0751-3
关键词
BRCA; cancer; cost-effectiveness; prevention; modeling
资金
- Cancer Council New South Wales (CCNSW) Strategic Research Partnership scheme [SRP12-03]
- Australian Government Research Training Program (RTP) Scholarship
Purpose Women who inherit a BRCA1 or BRCA2 pathogenic variant are at high risk of developing breast and ovarian cancer. Evidence for the effectiveness and cost-effectiveness of long-term management in clinical practice is lacking. The purpose of this study was to evaluate the real-world cost-effectiveness of BRCA carrier management within a structured clinical program. Methods Lifetime health outcomes and costs of clinical management for female unaffected BRCA carriers aged 20 were measured using a microsimulation model. For the intervention, women could attend a high-risk clinic, undergo risk-reducing surgery, and receive annual breast screening. Input data for the model was from a clinical database of 983 BRCA carriers. The comparator was no risk management. Outcomes were discounted at 5%. Results The incremental cost-effectiveness ratio for the program was $32,359 to $48,263 per quality-adjusted life-year (QALY). Limiting uptake of risk-reducing salpingo-oophorectomy to BRCA2 due to increased risk-reducing mastectomy costs with smaller incremental health benefit. Conclusion Long-term management of BRCA carriers within a structured clinical program is cost-effective. Suboptimal adherence to risk management guidelines can substantially affect outcomes and is an important consideration for future studies.
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