Cost-Effectiveness Analysis (CEA) of Surveillance and Preventive Strategies of Ovarian Cancer in Women With BRCA1/2 Pathogenic Variants

Speaker(s)

ABSTRACT WITHDRAWN

OBJECTIVES: Pathogenic Variants (PVs) in BRCA1/2 genes are associated with elevated risk of breast cancer (BC) and ovarian cancer (OC) with significant clinical and socioeconomic burden. Prevention of cancer risk in BRCA1/2 PV carriers varies among countries with different combinations of preventive and surveillance strategies. This study wanted to assess cost-effectiveness of a combined OC surveillance and prevention strategy in BRCA1/2 PV carriers.

METHODS: A Markov decision model was developed to simulate progression of BC and OC in BRCA1/2 PV carriers separately. The model estimated benefits and costs associated with three OC surveillance and/or preventive strategies: the Surveillance-Surgery Strategy (SSS), with annual surveillance until salpingo-oophorectomy and radical mastectomy at an appropriate age; the Only-Surgery Strategy (OSS) proposing only risk-reducing interventions and the No preventive Intervention Strategy (NIS) without any strategy. The analysis adopted the Italian national healthcare system perspective and a lifetime horizon, with direct healthcare costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) as outcome measures. Base-case, deterministic and probabilistic sensitivity analyses were performed.

RESULTS: In BRCA1 PV carriers, SSS yielded lifetime per patient cost savings of €8,382 and €2,008 compared to NIS and OSS, respectively, gaining 2.65 and 0.45 QALYs per patient. Similar trends were observed for BRCA2 PV carriers, with cost reduction of €3,279 and €349 implementing SSS vs NIS and OSS strategies and a gain of 1.65 and 0.16 QALYs respectively. Sensitivity analyses confirmed SS strategy as the dominant strategy across all scenarios, with a >80% probability of being most cost-effective at a willingness-to-pay threshold of €20,000 per QALY gained.

CONCLUSIONS: A combined OC surveillance and prevention strategy for BRCA1/2 PV carriers at an appropriate age represents a highly cost-effective approach compared to surgical prophylaxis alone or no intervention. High surgical acceptance rates are crucial for maximizing the effectiveness of such programs.

Code

EE706

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Oncology