Applied Health Economics and Health Policy

, Volume 12, Issue 2, pp 203–217 | Cite as

Economic Evaluation of Using a Genetic Test to Direct Breast Cancer Chemoprevention in White Women with a Previous Breast Biopsy

  • Linda E. Green
  • Tuan A. Dinh
  • David A. Hinds
  • Bryan L. Walser
  • Richard Allman
Original Research Article

Abstract

Background

Tamoxifen therapy reduces the risk of breast cancer but increases the risk of serious adverse events including endometrial cancer and thromboembolic events.

Objectives

The cost effectiveness of using a commercially available breast cancer risk assessment test (BREVAGen™) to inform the decision of which women should undergo chemoprevention by tamoxifen was modeled in a simulated population of women who had undergone biopsies but had no diagnosis of cancer.

Methods

A continuous time, discrete event, mathematical model was used to simulate a population of white women aged 40–69 years, who were at elevated risk for breast cancer because of a history of benign breast biopsy. Women were assessed for clinical risk of breast cancer using the Gail model and for genetic risk using a panel of seven common single nucleotide polymorphisms. We evaluated the cost effectiveness of using genetic risk together with clinical risk, instead of clinical risk alone, to determine eligibility for 5 years of tamoxifen therapy. In addition to breast cancer, the simulation included health states of endometrial cancer, pulmonary embolism, deep-vein thrombosis, stroke, and cataract. Estimates of costs in 2012 US dollars were based on Medicare reimbursement rates reported in the literature and utilities for modeled health states were calculated as an average of utilities reported in the literature. A 50-year time horizon was used to observe lifetime effects including survival benefits.

Results

For those women at intermediate risk of developing breast cancer (1.2–1.66 % 5-year risk), the incremental cost-effectiveness ratio for the combined genetic and clinical risk assessment strategy over the clinical risk assessment-only strategy was US$47,000, US$44,000, and US$65,000 per quality-adjusted life-year gained, for women aged 40–49, 50–59, and 60–69 years, respectively (assuming a price of US$945 for genetic testing). Results were sensitive to assumptions about patient adherence, utility of life while taking tamoxifen, and cost of genetic testing.

Conclusions

From the US payer’s perspective, the combined genetic and clinical risk assessment strategy may be a moderately cost-effective alternative to using clinical risk alone to guide chemoprevention recommendations for women at intermediate risk of developing breast cancer.

References

  1. 1.
    Cuzick J, Forbes J, Edwards R, et al. First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet. 2002;360:817–24.PubMedGoogle Scholar
  2. 2.
    Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90:1371–88.PubMedGoogle Scholar
  3. 3.
    Powles T, Eeles R, Ashley S, et al. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet. 1998;352:98–101.PubMedGoogle Scholar
  4. 4.
    Veronesi U, Maisonneuve P, Costa A, et al. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Italian Tamoxifen Prevention Study. Lancet. 1998;352:93–7.PubMedGoogle Scholar
  5. 5.
    Chemoprevention of Breast Cancer. Recommendation and Rationale. Rockville, MD: Agency for Healthcare Research and Quality; 2002. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/3rduspstf/breastchemo/breastchemorr.htm. Accessed 28 May 2013.
  6. 6.
    Nelson HD, Smith ME, Griffin JC, Fu R. Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158:604–14.PubMedGoogle Scholar
  7. 7.
    Visvanathan K, Chlebowski RT, Hurley P, et al. American Society of Clinical Oncology clinical practice guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction. J Clin Oncol. 2009;27:3235–58.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Armstrong K, Quistberg DA, Micco E, Domchek S, Guerra C. Prescription of tamoxifen for breast cancer prevention by primary care physicians. Arch Intern Med. 2006;166:2260–5.PubMedGoogle Scholar
  9. 9.
    Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879–86.PubMedGoogle Scholar
  10. 10.
    Breast Cancer Risk Assessment Tool (BCRAT). National Cancer Institute. http://www.cancer.gov/bcrisktool/. Accessed 20 Dec 2012.
  11. 11.
    Melnikow J, Kuenneth C, Helms LJ, et al. Chemoprevention: drug pricing and mortality: the case of tamoxifen. Cancer. 2006;107:950–8.PubMedGoogle Scholar
  12. 12.
    Noah-Vanhoucke J, Green LE, Dinh TA, Alperin P, Smith RA. Cost-effectiveness of chemoprevention of breast cancer using tamoxifen in a postmenopausal US population. Cancer. 2011;117:3322–31.PubMedGoogle Scholar
  13. 13.
    Clinical Practice Guidelines for Oncology. Breast Cancer Risk Reduction. Version 1.2013. National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf. Accessed 28 May 2013.
  14. 14.
    Mealiffe ME, Stokowski RP, Rhees BK, Prentice RL, Pettinger M, Hinds DA. Assessment of clinical validity of a breast cancer risk model combining genetic and clinical information. J Natl Cancer Inst. 2010;102:1618–27.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Comen E, Balistreri L, Gonen M, et al. Discriminatory accuracy and potential clinical utility of genomic profiling for breast cancer risk in BRCA-negative women. Breast Cancer Res Treat. 2011;127:479–87.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Beery TA, Williams JK. Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders. Genet Test. 2007;11:111–23.PubMedGoogle Scholar
  17. 17.
    Garcia-Closas M, Chanock S. Genetic susceptibility loci for breast cancer by estrogen receptor status. Clin Cancer Res. 2008;14:8000–9.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Garcia-Closas M, Hall P, Nevanlinna H, et al. Heterogeneity of breast cancer associations with five susceptibility loci by clinical and pathological characteristics. PLoS Genet. 2008;4:e1000054.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Stacey SN, Manolescu A, Sulem P, et al. Common variants on chromosomes 2q35 and 16q12 confer susceptibility to estrogen receptor-positive breast cancer. Nat Genet. 2007;39:865–9.PubMedGoogle Scholar
  20. 20.
    Stacey SN, Manolescu A, Sulem P, et al. Common variants on chromosome 5p12 confer susceptibility to estrogen receptor-positive breast cancer. Nat Genet. 2008;40:703–6.PubMedGoogle Scholar
  21. 21.
    Easton DF, Pooley KA, Dunning AM, et al. Genome-wide association study identifies novel breast cancer susceptibility loci. Nature. 2007;447:1087–93.PubMedCentralPubMedGoogle Scholar
  22. 22.
    National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch. SEER*Stat Database. Surveillance, Epidemiology, and End Results (SEER) Program 2007; Incidence—SEER 13 Regs Limited-Use, Nov 2006 Sub (1992-2004).Google Scholar
  23. 23.
    Ballard-Barbash R, Taplin SH, Yankaskas BC, et al. Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol. 1997;169:1001–8.PubMedGoogle Scholar
  24. 24.
    Calle EE, Rodriguez C, Jacobs EJ, et al. The American Cancer Society Cancer Prevention Study II Nutrition Cohort: rationale, study design, and baseline characteristics. Cancer. 2002;94:2490–501.PubMedGoogle Scholar
  25. 25.
    Cuzick J, Powles T, Veronesi U, et al. Overview of the main outcomes in breast-cancer prevention trials. Lancet. 2003;361:296–300.PubMedGoogle Scholar
  26. 26.
    Cuzick J, Forbes JF, Sestak I, et al. Long-term results of tamoxifen prophylaxis for breast cancer: 96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst. 2007;99:272–82.PubMedGoogle Scholar
  27. 27.
    Powles TJ, Ashley S, Tidy A, Smith IE, Dowsett M. Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst. 2007;99:283–90.PubMedGoogle Scholar
  28. 28.
    Barron TI, Connolly R, Bennett K, Feely J, Kennedy MJ. Early discontinuation of tamoxifen: a lesson for oncologists. Cancer. 2007;109:832–9.PubMedGoogle Scholar
  29. 29.
    National Health and Nutrition Examination Survey Data 1999-2006. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). http://www.cdc.gov.ezproxy.dominican.edu/nchs/nhanes.htm. Accessed 20 Dec 2012.
  30. 30.
    Pinsky PF, Kramer BS, Reding D, Buys S, PLCO Project Team. Reported family history of cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. Am J Epidemiol. 2003;157:792–9.PubMedGoogle Scholar
  31. 31.
    Consumer Price Index. Bureau of Labor Statistics, U.S. Department of Labor. http://www.bls.gov/cpi. Accessed 20 Dec 2012.
  32. 32.
    HealthWarehouse.com. (http://www.healthwarehouse.com. Accessed 20 Dec 2012.
  33. 33.
    Center for the Evaluation of Value and Risk in Health (CEA Registry). Tufts Medical Center Institute for Clinical Research and Health Policy Studies. https://research.tufts-nemc.org/cear4/default.aspx. Accessed 5 July 2011.
  34. 34.
    Mourits MJ, De Vries EG, Willemse PH, Ten Hoor KA, Hollema H, Van der Zee AG. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecol. 2001;97:855–66.PubMedGoogle Scholar
  35. 35.
    Gail MH, Costantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst. 1999;91:1829–46.PubMedGoogle Scholar
  36. 36.
    Freedman AN, Graubard BI, Rao SR, McCaskill-Stevens W, Ballard-Barbash R, Gail MH. Estimates of the number of US women who could benefit from tamoxifen for breast cancer chemoprevention. J Natl Cancer Inst. 2003;95:526–32.PubMedGoogle Scholar
  37. 37.
    Samsa GP, Bian J, Lipscomb J, Matchar DB. Epidemiology of recurrent cerebral infarction: a Medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost. Stroke. 1999;30:338–49.PubMedGoogle Scholar
  38. 38.
    Ahmed S, Thomas G, Ghoussaini M, et al. Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2. Nat Genet. 2009;41:585–90.PubMedCentralPubMedGoogle Scholar
  39. 39.
    Thomas G, Jacobs KB, Kraft P, et al. A multistage genome-wide association study in breast cancer identifies two new risk alleles at 1p11.2 and 14q24.1 (RAD51L1). Nat Genet. 2009;41:579–84.PubMedCentralPubMedGoogle Scholar
  40. 40.
    Gail MH. Value of adding single-nucleotide polymorphism genotypes to a breast cancer risk model. J Natl Cancer Inst. 2009;101:959–63.PubMedCentralPubMedGoogle Scholar
  41. 41.
    Wacholder S, Hartge P, Prentice R, et al. Performance of common genetic variants in breast-cancer risk models. N Engl J Med. 2010;362:986–93.PubMedCentralPubMedGoogle Scholar
  42. 42.
    Melnikow J, Birch S, Slee C, McCarthy TJ, Helms LJ, Kuppermann M. Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis. Med Care. 2008;46:946–53.PubMedGoogle Scholar
  43. 43.
    Current Trials Working Party of the Cancer Research, Campaign Breast Cancer Trials Group. Preliminary results from the cancer research campaign trial evaluating tamoxifen duration in women aged fifty years or older with breast cancer. J Natl Cancer Inst. 1996;88:1834–9.Google Scholar
  44. 44.
    Spiegelman D, Colditz GA, Hunter D, Hertzmark E. Validation of the Gail et al. model for predicting individual breast cancer risk. J Natl Cancer Inst. 1994;86:600–7.Google Scholar
  45. 45.
    Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet. 1997;350:1047–59.Google Scholar
  46. 46.
    Key T, Appleby P, Barnes I, Reeves G, Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst. 2002;94:606–16.PubMedGoogle Scholar
  47. 47.
    Green LE, Dinh TA, Smith RA. An estrogen model: the relationship between body mass index, menopausal status, estrogen replacement therapy, and breast cancer risk. Comput Math Methods Med. 2012;2012:792375.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Hoover DR, Crystal S, Kumar R, Sambamoorthi U, Cantor JC. Medical expenditures during the last year of life: findings from the 1992–1996 Medicare current beneficiary survey. Health Serv Res. 2002;37:1625–42.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Auerbach AD, Sanders GD, Hambleton J. Cost-effectiveness of testing for hypercoagulability and effects on treatment strategies in patients with deep vein thrombosis. Am J Med. 2004;116:816–28.PubMedGoogle Scholar
  50. 50.
    Caro JJ, Getsios D, Caro I, O’Brien JA. Cost effectiveness of tinzaparin sodium versus unfractionated heparin in the treatment of proximal deep vein thrombosis. Pharmacoeconomics. 2002;20:593–602.PubMedGoogle Scholar
  51. 51.
    Haentjens P, De Groote K, Annemans L. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement: a cost-utility analysis. Arch Orthop Trauma Surg. 2004;124:507–17.PubMedGoogle Scholar
  52. 52.
    Lekander I, Borgstrom F, Strom O, Zethraeus N, Kanis JA. Cost-effectiveness of hormone therapy in the United States. J Womens Health (Larchmt). 2009;18:1669–77.Google Scholar
  53. 53.
    Locker GY, Mansel R, Cella D, et al. Cost-effectiveness analysis of anastrozole versus tamoxifen as primary adjuvant therapy for postmenopausal women with early breast cancer: a US healthcare system perspective. The 5-year completed treatment analysis of the ATAC (‘Arimidex’, Tamoxifen Alone or in Combination) trial. Breast Cancer Res Treat. 2007;106:229–38.PubMedGoogle Scholar
  54. 54.
    Marchetti M, Pistorio A, Barone M, Serafini S, Barosi G. Low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: a cost-effectiveness analysis. Am J Med. 2001;111:130–9.PubMedGoogle Scholar
  55. 55.
    Chau Q, Cantor SB, Caramel E, et al. Cost-effectiveness of the bird’s nest filter for preventing pulmonary embolism among patients with malignant brain tumors and deep venous thrombosis of the lower extremities. Support Care Cancer. 2003;11:795–9.PubMedGoogle Scholar
  56. 56.
    Cykert S, Phifer N, Hansen C. Tamoxifen for breast cancer prevention: a framework for clinical decisions. Obstet Gynecol. 2004;104:433–42.PubMedGoogle Scholar
  57. 57.
    Mansel R, Locker G, Fallowfield L, Benedict A, Jones D. Cost-effectiveness analysis of anastrozole vs tamoxifen in adjuvant therapy for early stage breast cancer in the United Kingdom: the 5-year completed treatment analysis of the ATAC (‘Arimidex’, Tamoxifen alone or in combination) trial. Br J Cancer. 2007;97:152–61.PubMedCentralPubMedGoogle Scholar
  58. 58.
    Salpeter SR, Buckley NS, Liu H, Salpeter EE. The cost-effectiveness of hormone therapy in younger and older postmenopausal women. Am J Med. 2009;122(42–52):e2.PubMedGoogle Scholar
  59. 59.
    ten Cate-Hoek AJ, Dielis AW, Spronk HM, et al. Thrombin generation in patients after acute deep-vein thrombosis. Thromb Haemost. 2008;100:240–5.PubMedGoogle Scholar
  60. 60.
    Brandle M, Azoulay M, Greiner RA. Cost-effectiveness and cost-utility of insulin glargine compared with NPH insulin based on a 10-year simulation of long-term complications with the Diabetes Mellitus Model in patients with type 2 diabetes in Switzerland. Int J Clin Pharmacol Ther. 2007;45:203–20.PubMedGoogle Scholar
  61. 61.
    Brown GC, Brown MM, Brown HC, Kindermann S, Sharma S. A value-based medicine comparison of interventions for subfoveal neovascular macular degeneration. Ophthalmology. 2007;114:1170–8.PubMedGoogle Scholar
  62. 62.
    Cohen N, Minshall ME, Sharon-Nash L, Zakrzewska K, Valentine WJ, Palmer AJ. Continuous subcutaneous insulin infusion versus multiple daily injections of insulin: economic comparison in adult and adolescent type 1 diabetes mellitus in Australia. Pharmacoeconomics. 2007;25:881–97.PubMedGoogle Scholar
  63. 63.
    Grann VR, Sundararajan V, Jacobson JS, et al. Decision analysis of tamoxifen for the prevention of invasive breast cancer. Cancer J. 2000;6:169–78.PubMedGoogle Scholar
  64. 64.
    Hershman D, Sundararajan V, Jacobson JS, Heitjan DF, Neugut AI, Grann VR. Outcomes of tamoxifen chemoprevention for breast cancer in very high-risk women: a cost-effectiveness analysis. J Clin Oncol. 2002;20:9–16.PubMedGoogle Scholar
  65. 65.
    Hopkins RB, Tarride JE, Bowen J, et al. Cost-effectiveness of reducing wait times for cataract surgery in Ontario. Can J Ophthalmol. 2008;43:213–7.PubMedGoogle Scholar
  66. 66.
    Ruof J, Golay A, Berne C, Collin C, Lentz J, Maetzel A. Orlistat in responding obese type 2 diabetic patients: meta-analysis findings and cost-effectiveness as rationales for reimbursement in Sweden and Switzerland. Int J Obes (Lond). 2005;29:517–23.Google Scholar
  67. 67.
    Tunis SL, Minshall ME, Charles M, Pandya BJ, Baran RW. Pioglitazone versus rosiglitazone treatment in patients with type 2 diabetes and dyslipidemia: cost-effectiveness in the US. Curr Med Res Opin. 2008;24:3085–96.PubMedGoogle Scholar
  68. 68.
    Armstrong K, Chen TM, Albert D, Randall TC, Schwartz JS. Cost-effectiveness of raloxifene and hormone replacement therapy in postmenopausal women: impact of breast cancer risk. Obstet Gynecol. 2001;98:996–1003.PubMedGoogle Scholar
  69. 69.
    Delea TE, El-Ouagari K, Karnon J, Sofrygin O. Cost-effectiveness of letrozole versus tamoxifen as initial adjuvant therapy in postmenopausal women with hormone-receptor positive early breast cancer from a Canadian perspective. Breast Cancer Res Treat. 2008;108:375–87.PubMedGoogle Scholar
  70. 70.
    Sonnenberg FA, Burkman RT, Hagerty CG, Speroff L, Speroff T. Costs and net health effects of contraceptive methods. Contraception. 2004;69:447–59.PubMedGoogle Scholar
  71. 71.
    El Ouagari K, Karnon J, Delea T, Talbot W, Brandman J. Cost-effectiveness of letrozole in the extended adjuvant treatment of women with early breast cancer. Breast Cancer Res Treat. 2007;101:37–49.PubMedGoogle Scholar
  72. 72.
    Elkin EB, Weinstein MC, Winer EP, Kuntz KM, Schnitt SJ, Weeks JC. HER-2 testing and trastuzumab therapy for metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol. 2004;22:854–63.PubMedGoogle Scholar
  73. 73.
    Kanis JA, Borgstrom F, Johnell O, Oden A, Sykes D, Jonsson B. Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study. Osteoporos Int. 2005;16:15–25.PubMedGoogle Scholar
  74. 74.
    Lee JH, Glick HA, Hayman JA, Solin LJ. Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients. J Clin Oncol. 2002;20:2713–25.PubMedGoogle Scholar
  75. 75.
    Lievens Y, Kesteloot K, van den Bogaert W. Economic consequence of local control with radiotherapy: cost analysis of internal mammary and medial supraclavicular lymph node radiotherapy in breast cancer. Int J Radiat Oncol Biol Phys. 2005;63:1122–31.PubMedGoogle Scholar
  76. 76.
    Norum J, Olsen JA, Wist EA, Lonning PE. Trastuzumab in adjuvant breast cancer therapy: a model based cost-effectiveness analysis. Acta Oncol. 2007;46:153–64.PubMedGoogle Scholar
  77. 77.
    Stevenson MD, Oakley J, Chilcott JB. Gaussian process modeling in conjunction with individual patient simulation modeling: a case study describing the calculation of cost-effectiveness ratios for the treatment of established osteoporosis. Med Decis Making. 2004;24:89–100.PubMedGoogle Scholar
  78. 78.
    Danova M, Chiroli S, Rosti G, Doan QV. Cost-effectiveness of pegfilgrastim versus six days of filgrastim for preventing febrile neutropenia in breast cancer patients. Tumori. 2009;95:219–26.PubMedGoogle Scholar
  79. 79.
    Lyman GH, Lalla A, Barron RL, Dubois RW. Cost-effectiveness of pegfilgrastim versus filgrastim primary prophylaxis in women with early-stage breast cancer receiving chemotherapy in the United States. Clin Ther. 2009;31:1092–104.PubMedGoogle Scholar
  80. 80.
    Ramsey SD, Liu Z, Boer R, et al. Cost-effectiveness of primary versus secondary prophylaxis with pegfilgrastim in women with early-stage breast cancer receiving chemotherapy. Value Health. 2009;12:217–25.PubMedGoogle Scholar
  81. 81.
    Martin SC, Gagnon DD, Zhang L, Bokemeyer C, Van Marwijk Kooy M, van Hout B. Cost-utility analysis of survival with epoetin-alfa versus placebo in stage IV breast cancer. Pharmacoeconomics. 2003;21:1153–69.PubMedGoogle Scholar
  82. 82.
    Meadows ES, Klein R, Rousculp MD, Smolen L, Ohsfeldt RL, Johnston JA. Cost-effectiveness of preventative therapies for postmenopausal women with osteopenia. BMC Womens Health. 2007;7:6.PubMedCentralPubMedGoogle Scholar
  83. 83.
    Risebrough NA, Verma S, Trudeau M, Mittmann N. Cost-effectiveness of switching to exemestane versus continued tamoxifen as adjuvant therapy for postmenopausal women with primary breast cancer. Cancer. 2007;110:499–508.PubMedGoogle Scholar
  84. 84.
    Rojnik K, Naversnik K, Mateovic-Rojnik T, Primiczakelj M. Probabilistic cost-effectiveness modeling of different breast cancer screening policies in Slovenia. Value Health. 2008;11:139–48.PubMedGoogle Scholar
  85. 85.
    Bosch JL, Beinfeld MT, Muller JE, Brady T, Gazelle GS. A cost-effectiveness analysis of a hypothetical catheter-based strategy for the detection and treatment of vulnerable coronary plaques with drug-eluting stents. J Interv Cardiol. 2005;18:339–49.PubMedGoogle Scholar
  86. 86.
    Buskens E, Nederkoorn PJ, Buijs-Van Der Woude T, et al. Imaging of carotid arteries in symptomatic patients: cost-effectiveness of diagnostic strategies. Radiology. 2004;233:101–12.Google Scholar
  87. 87.
    Chambers MG, Koch P, Hutton J. Development of a decision-analytic model of stroke care in the United States and Europe. Value Health. 2002;5:82–97.PubMedGoogle Scholar
  88. 88.
    Chan PS, Nallamothu BK, Gurm HS, Hayward RA, Vijan S. Incremental benefit and cost-effectiveness of high-dose statin therapy in high-risk patients with coronary artery disease. Circulation. 2007;115:2398–409.PubMedGoogle Scholar
  89. 89.
    Cram P, Vijan S, Katz D, Fendrick AM. Cost-effectiveness of in-home automated external defibrillators for individuals at increased risk of sudden cardiac death. J Gen Intern Med. 2005;20:251–8.PubMedCentralPubMedGoogle Scholar
  90. 90.
    Derdeyn CP, Gage BF, Grubb RL Jr, Powers WJ. Cost-effectiveness analysis of therapy for symptomatic carotid occlusion: PET screening before selective extracranial-to-intracranial bypass versus medical treatment. J Nucl Med. 2000;41:800–7.PubMedGoogle Scholar
  91. 91.
    Desbiens NA. Deciding on anticoagulating the oldest old with atrial fibrillation: insights from cost-effectiveness analysis. J Am Geriatr Soc. 2002;50:863–9.PubMedGoogle Scholar
  92. 92.
    Greving JP, Buskens E, Koffijberg H, Algra A. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation. 2008;117:2875–83.PubMedGoogle Scholar
  93. 93.
    Henriksson M, Lundgren F, Carlsson P. Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis. Br J Surg. 2008;95:714–20.PubMedGoogle Scholar
  94. 94.
    Janssen MP, de Borst GJ, Mali WP, et al. Carotid stenting versus carotid endarterectomy: evidence basis and cost implications. Eur J Vasc Endovasc Surg. 2008;36:258–64.PubMedGoogle Scholar
  95. 95.
    Jonsson B, Carides GW, Burke TA, et al. Cost effectiveness of losartan in patients with hypertension and LVH: an economic evaluation for Sweden of the LIFE trial. J Hypertens. 2005;23:1425–31.PubMedGoogle Scholar
  96. 96.
    Karnon J, Holmes MW, Williams R, Bakhai A, Brennan A. A cost-utility analysis of clopidogrel in patients with ST elevation acute coronary syndromes in the UK. Int J Cardiol. 2010;140:315–22.PubMedGoogle Scholar
  97. 97.
    Kreisz FP, Merlin T, Moss J, Atherton J, Hiller JE, Gericke CA. The pre-test risk stratified cost-effectiveness of 64-slice computed tomography coronary angiography in the detection of significant obstructive coronary artery disease in patients otherwise referred to invasive coronary angiography. Heart Lung Circ. 2009;18:200–7.PubMedGoogle Scholar
  98. 98.
    Latimer N, Lord J, Grant RL, et al. Cost effectiveness of COX 2 selective inhibitors and traditional NSAIDs alone or in combination with a proton pump inhibitor for people with osteoarthritis. BMJ. 2009;339:b2538.PubMedCentralPubMedGoogle Scholar
  99. 99.
    Marchetti M, Quaglini S, Barosi G. Cost-effectiveness of screening and extended anticoagulation for carriers of both factor V Leiden and prothrombin G20210A. QJM. 2001;94:365–72.PubMedGoogle Scholar
  100. 100.
    Maud A, Lakshminarayan K, Suri MF, Vazquez G, Lanzino G, Qureshi AI. Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg. 2009;110:880–6.PubMedCentralPubMedGoogle Scholar
  101. 101.
    Mayer SA, Copeland D, Bernardini GL, et al. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke. 2000;31:2346–53.PubMedGoogle Scholar
  102. 102.
    Meenan RT, Saha S, Chou R, et al. Cost-effectiveness of echocardiography to identify intracardiac thrombus among patients with first stroke or transient ischemic attack. Med Decis Making. 2007;27:161–77.PubMedGoogle Scholar
  103. 103.
    Newman J, Grobman WA, Greenland P. Combination polypharmacy for cardiovascular disease prevention in men: a decision analysis and cost-effectiveness model. Prev Cardiol. 2008;11:36–41.PubMedGoogle Scholar
  104. 104.
    Patrick AR, Avorn J, Choudhry NK. Cost-effectiveness of genotype-guided warfarin dosing for patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2009;2:429–36.PubMedGoogle Scholar
  105. 105.
    Post PN, Kievit J, van Baalen JM, van den Hout WB, van Bockel JH. Routine duplex surveillance does not improve the outcome after carotid endarterectomy: a decision and cost utility analysis. Stroke. 2002;33:749–55.PubMedGoogle Scholar
  106. 106.
    Quilici S, Martin M, McGuire A, Zoellner Y. A cost-effectiveness analysis of n-3 PUFA (Omacor) treatment in post-MI patients. Int J Clin Pract. 2006;60:922–32.PubMedGoogle Scholar
  107. 107.
    Saito I, Kobayashi M, Matsushita Y, Mori A, Kawasugi K, Saruta T. Cost-utility analysis of antihypertensive combination therapy in Japan by a Monte Carlo simulation model. Hypertens Res. 2008;31:1373–83.PubMedGoogle Scholar
  108. 108.
    Saka O, Serra V, Samyshkin Y, McGuire A, Wolfe CC. Cost-effectiveness of stroke unit care followed by early supported discharge. Stroke. 2009;40:24–9.PubMedGoogle Scholar
  109. 109.
    Schleinitz MD, Heidenreich PA. A cost-effectiveness analysis of combination antiplatelet therapy for high-risk acute coronary syndromes: clopidogrel plus aspirin versus aspirin alone. Ann Intern Med. 2005;142:251–9.PubMedGoogle Scholar
  110. 110.
    Scuffham PA, Tippett V. The cost-effectiveness of thrombolysis administered by paramedics. Curr Med Res Opin. 2008;24:2045–58.PubMedGoogle Scholar
  111. 111.
    Sorensen SV, Dewilde S, Singer DE, Goldhaber SZ, Monz BU, Plumb JM. Cost-effectiveness of warfarin: trial versus “real-world” stroke prevention in atrial fibrillation. Am Heart J. 2009;157:1064–73.PubMedGoogle Scholar
  112. 112.
    Stahl JE, Furie KL, Gleason S, Gazelle GS. Stroke: effect of implementing an evaluation and treatment protocol compliant with NINDS recommendations. Radiology. 2003;228:659–68.PubMedGoogle Scholar
  113. 113.
    Young KC, Awad NA, Johansson M, Gillespie D, Singh MJ, Illig KA. Cost-effectiveness of abdominal aortic aneurysm repair based on aneurysm size. J Vasc Surg. 2010;51:27–32.PubMedGoogle Scholar
  114. 114.
    Aujesky D, Smith KJ, Roberts MS. Oral anticoagulation strategies after a first idiopathic venous thromboembolic event. Am J Med. 2005;118:625–35.PubMedGoogle Scholar
  115. 115.
    Bravo Vergel Y, Palmer S, Asseburg C, et al. Is primary angioplasty cost effective in the UK? Results of a comprehensive decision analysis. Heart. 2007;93:1238–43.Google Scholar
  116. 116.
    Gerson LB, Triadafilopoulos G, Gage BF. The management of anticoagulants in the periendoscopic period for patients with atrial fibrillation: a decision analysis. Am J Med. 2004;116:451–9.PubMedGoogle Scholar
  117. 117.
    Marchetti M, Pistorio A, Barosi G. Extended anticoagulation for prevention of recurrent venous thromboembolism in carriers of factor V Leiden–cost-effectiveness analysis. Thromb Haemost. 2000;84:752–7.PubMedGoogle Scholar
  118. 118.
    Perone N, Bounameaux H, Perrier A. Comparison of four strategies for diagnosing deep vein thrombosis: a cost-effectiveness analysis. Am J Med. 2001;110:33–40.PubMedGoogle Scholar
  119. 119.
    Pignone M, Earnshaw S, Pletcher MJ, Tice JA. Aspirin for the primary prevention of cardiovascular disease in women: a cost-utility analysis. Arch Intern Med. 2007;167:290–5.PubMedGoogle Scholar
  120. 120.
    Quinn RR, Naimark DM, Oliver MJ, Bayoumi AM. Should hemodialysis patients with atrial fibrillation undergo systemic anticoagulation? A cost-utility analysis. Am J Kidney Dis. 2007;50:421–32.PubMedGoogle Scholar
  121. 121.
    Sarasin FP, Gaspoz JM, Bounameaux H. Cost-effectiveness of new antiplatelet regimens used as secondary prevention of stroke or transient ischemic attack. Arch Intern Med. 2000;160:2773–8.PubMedGoogle Scholar
  122. 122.
    Sinclair SE, Frighetto L, Loewen PS, et al. Cost-utility analysis of tissue plasminogen activator therapy for acute ischaemic stroke: a Canadian healthcare perspective. Pharmacoeconomics. 2001;19:927–36.PubMedGoogle Scholar
  123. 123.
    U-King-Im JM, Hollingworth W, Trivedi RA, et al. Cost-effectiveness of diagnostic strategies prior to carotid endarterectomy. Ann Neurol. 2005;58:506–15.PubMedGoogle Scholar
  124. 124.
    Regier DA, Sunderji R, Lynd LD, Gin K, Marra CA. Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy. CMAJ. 2006;174:1847–52.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Linda E. Green
    • 1
    • 2
  • Tuan A. Dinh
    • 2
    • 7
  • David A. Hinds
    • 3
    • 5
  • Bryan L. Walser
    • 3
    • 6
  • Richard Allman
    • 4
  1. 1.Department of MathematicsUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Archimedes, Inc.San FranciscoUSA
  3. 3.Perlegen Sciences, Inc.Mountain ViewUSA
  4. 4.Genetic Technologies Ltd.FitzroyAustralia
  5. 5.23andMe, Inc.Mountain ViewUSA
  6. 6.Allergen Research CorporationSan MateoUSA
  7. 7.EvideraSan FranciscoUSA

Personalised recommendations