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The Cost-Effectiveness of Prevention Strategies for Individuals Who Carry CSGs for Ovarian Cancer and Breast Cancer
A recent study by Ranjit Manchada, PhD, Queen Mary University of London, and colleagues estimated the cost-effectiveness of prevention strategies for ovarian cancer (OC) and prevention and/or surveillance strategies for breast cancer (BC) risk reduction for individuals who carry cancer susceptibility genes (CSGs). Their findings were presented at the 2024 Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer.
The authors conducted their analysis from the perspective of UK health system payers. They used a decision-analytic Markov model to evaluate the cost-effectiveness of risk-reducing salpingo-oophorectomy (RRSO) and, where relevant, risk-reducing mastectomy (RRM). They then compared these methods with non-surgical interventions (including BC surveillance and medical prevention [tamoxifen/anastrozole] for increased BC risk) among patients who carry BRCA1, BRCA2, PALB2, RAD51C, RAD51D, and BRIP1 pathogenic variants (PVs). Sensitivity and scenario analysis were also performed.
The CSG-dependent interventions included in the study were as follows: If the patient underwent RRSO at age 35-50 years with or without BC surveillance and medical prevention from age 30 or 40 years; if the patient had undergone RRM at age 30 to 40 years; if they had both RRSO and RRM; if they had BC surveillance and medical prevention; or if they had no intervention. For the study, incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained.
The results showed that undergoing both RRSO and RRM was most cost-effective for patients carrying the PVs BRCA1 (RRM: 30 years; RRSO: 35 years), BRCA2 (RRM: 35 years; RRSO: 40 years), and PALB2 (RRM: 40 years; RRSO: 45 years), with ICERs of £-1,942 (US $-2471.38)/QALY, £-89 (US $-113.26)/QALY, and £2,381 (US $3030.05)/QALY, respectively. In addition, RRSO at age 45 was found to be cost-effective for patients carrying RAD51C (£962 (US $1224.24/QALY), RAD51D (£771 (US $981.17)/QALY), and BRIP1 (£2,355 (US $2996.96)/QALY) PV compared to non-surgical strategies.
In terms of OC and BC cases and deaths, the most cost-effective preventive strategy per 1,000 PV carriers could prevent 923 OC/BC cases and 302 deaths among those who carry BRCA1; 686 OC/BC cases and 170 deaths among those who carry BRCA; 464 OC/BC cases and 130 deaths among those who carry PALB2; 102 OC cases and 64 deaths among those who carry RAD51C; 118 OC cases and 76 deaths among those who carry RAD51D; and 55 OC cases and 37 deaths among those who carry BRIP1.
According to the probabilistic sensitivity analysis, both RRSO and RRM were most cost-effective in 96.5% of simulations for BRCA1, 89.2% for BRCA2, and 84.8% for PALB2. Notably, RRSO was cost-effective in 100% of simulations for PVs RAD51C, RAD51D, and BRIP1.
Overall, the study found that for patients who carry BRCA1, BRCA2, PALB2, RAD51C, RAD51D, and BRIP1 PVs who had undergone RRSO with or without RRM at varying respective optimal ages, it was more cost-effective when compared to non-surgical strategies.
Source: Manchada R, Wei X, Sun L, et al. Cost-effectiveness analysis of cancer susceptibility gene-specific prevention strategies for ovarian and breast cancer. Presented at the 2024 Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer; March 16-March 18, 2024. San Diego, California.
