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Title: Cost-effectiveness of long-term clinical management of BRCA pathogenic variant carriers.
Austin Authors: Petelin, Lara;Hossack, Lucinda;Shanahan, Mary;Mitchell, Gillian;Liew, Danny;James, Paul A;Trainer, Alison H
Affiliation: Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, VIC, Melbourne, Australia
Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, VIC, Melbourne, Australia
The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Melbourne, Australia
Department of Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
School of Public Health and Preventive Medicine, Monash University, VIC, Melbourne, Australia
Issue Date: 30-Jan-2020 2020-01-30
Publication information: Genetics in medicine 2020; 22(5): 831-839
Abstract: 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. 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%. 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 <50% of carriers decreased cost-effectiveness by $7000-8000 per QALY. Achieving perfect adherence to guidelines was less cost-effective for BRCA2 due to increased risk-reducing mastectomy costs with smaller incremental health benefit. 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.
DOI: 10.1038/s41436-020-0751-3
ORCID: 0000-0003-3245-8895
PubMed URL: 31996782
Type: Journal Article
Subjects: BRCA
Appears in Collections:Journal articles

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