Cost-effectiveness of universal screening for germline BRCA mutations in metastatic pancreatic cancer.

Abstract

536 Background: Germline BRCA1/2 mutations (gBRCAm) increase the risk of pancreatic ductal adenocarcinoma (PDAC). The NCCN 2020 guidelines recommend testing for gBRCAm in metastatic PDAC patients if the patients have a personal history and/or familial history of PDAC (current standard-of-care). However, given the advances made in genetic testing, universal gBRCAm testing for metastatic PDAC patients can be considered. The cost-effectiveness of universal gBRCAm screening has yet to be compared to the current standard-of-care. The purpose of our study was to explore the cost-effectiveness, treatment outcomes, costs, and quality-of-life impact of universal gBRCAm screening. Methods: We developed a decision-analytic mathematical model comparing the cost and health outcomes of universal gBRCAm screening against the current standard-of-care. Inputs for the model were estimated using clinical trial data and published literature. No intervention was used as a comparator. The primary endpoint was incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted-life-year (QALY). Secondary endpoints included overall survival (OS), progression-free survival (PFS), life-years (LYs) and total cost of care (USD). Results: Universal gBRCAm screening was the cost-effective strategy, totaling incremental QALYs of 1.61 at a cost of $73,682 per QALY when compared to no intervention. A one-way sensitivity analysis found that the standard-of-care becomes the cost-effective strategy when the prevalence of gBRCAm is lowered to 2% of the base case. Conclusions: Our model found that universal gBRCAm screening is cost-effective and even cost-savings for patients with metastatic PDAC. Additional clinical trial data with sufficient follow-up are needed to confirm our findings.[Table: see text]