Cost\u2013utility analysis of germline BRCA1/2 testing in women with high-grade epithelial ovarian cancer in Spain

Carlota Moya-Alarcón,Inés Pérez-Román,Ana Beatriz Sánchez-Heras,Eloisa Bayo-Lozano,Antonio González-Martín,Susana Simon,Almudena González-Domínguez

doi:10.1007/s12094-018-02026-2

Abstract

PurposeGermline mutations in BRCA1 and/or BRCA2 genes (gBRCA1/2m) are associated with an increased risk of breast cancer (BC) and ovarian cancer (OC). The aim of this study was to estimate the efficiency of providing germline BRCA1/2 testing to high-grade epithelial ovarian cancer (HGEOC) patients without family history of OC or BC and the subsequent testing and management of their relatives with gBRCA1/2m in Spain.Methods/patientsIncident HGEOC patients without family history of OC or BC who were gBRCA1/2m carriers and their relatives were simulated in a 50-year time horizon. The study compared two scenarios: BRCA1/2 testing vs no testing, using the perspective of the Spanish National Health Service. Cancer risk among gBRCA1/2m carriers was estimated based on their age and whether they had undergone risk-reducing surgeries. Direct healthcare costs and utilities of patients who developed EOC and BC were also included. A probabilistic sensitivity analysis (PSA) with 5 thousand simulations was developed considering ± 25% of the base-case value.ResultsThe BRCA1/2-testing scenario amounted to €13,437,897.43 while the no-testing scenario amounted to €12,053,291.17. It was estimated that the screening test improved the quality of life among the patients’ relatives by 43.8 quality-adjusted life years (QALYs). The incremental cost–utility ratio (ICUR) was €31,621.33/QALY in the base case. The PSA showed that 89.12% of the simulations were below the €50,000/QALY threshold.ConclusionProviding this screening test to HGEOC patients and their relatives is cost-effective and it allows one to identify a target population with high risk of cancer to provide effective prevention strategies.

Highlights

Materials and methodsOvarian cancer (OC) is the fifth most frequent cancer among women in Spain [1]
Those results are in accordance with the recently updated guideline (SEOM 2015), which establishes that all patients with non-mucinous high-grade EOC (HGEOC) should be offered germline BRCA1/2 testing, regardless of family history of ovarian cancer (OC) or breast cancer (BC) [9]
Our results showed that providing germline BRCA1/2 testing for 50 years would decrease the number of EOC cases from 8 to 6 and BC cases from 20 to 7

Summary

Introduction

Materials and methodsOvarian cancer (OC) is the fifth most frequent cancer among women in Spain [1]. Recent research has shown that 71.3% of the patients suffer high-grade EOC (HGEOC), which grows steadily and is diagnosed at advanced stages (III and IV) [3]. In 2011, the Spanish Society of Medical Oncology (SEOM) guidelines established the eligibility criteria to offer genetic testing to gBRCA1/2m carriers with hereditary cancer. Alsop et al [8] showed that 74.8% of patients with HGEOC had no family history of BC/OC and that 8.3% of patients without family history were gBRCA1/2m carriers Those results are in accordance with the recently updated guideline (SEOM 2015), which establishes that all patients with non-mucinous HGEOC should be offered germline BRCA1/2 testing, regardless of family history of OC or BC [9]

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Conclusion