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Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer

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Abstract

Background

The ‘German Consortium for Hereditary Breast and Ovarian Cancer’ (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test.

Methods

A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of ≥ 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states ‘well’ (women with increased risk), ‘breast cancer without metastases’, ‘breast cancer with metastases’, ‘ovarian cancer’, ‘death’, and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC.

Results

Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of €7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of €17,027 per QALY; cost per LYG: €22,318). The results were robust in deterministic and probabilistic sensitivity analyses.

Conclusion

The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of ≥ 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.

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  1. Stephanie Stock and Kerstin Rhiem contributed equally to the manuscript.

Authors and Affiliations

  1. Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany

    Dirk Müller, Marion Danner & Stephanie Stock

  2. Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany

    Rita Schmutzler, Kirsten Wassermann & Kerstin Rhiem

  3. Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany

    Christoph Engel

  4. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Björn Stollenwerk

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The analysis was a part of the More-Risk Study, an evaluation of the economical, legal, ethical, and risk-communicative implications of a risk-adapted screening strategy to detect mamma- and ovarian cancer. The More-Risk Study was funded by the “Federal Ministry of Education and Research” (NKP-332-019).

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Müller, D., Danner, M., Schmutzler, R. et al. Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer. Eur J Health Econ 20, 739–750 (2019). https://doi.org/10.1007/s10198-019-01038-1

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