Cost-Effectiveness Analysis of Tumor Testing for BRCA Pathogenic Variants in Epithelial Ovarian Cancer.

IF 1.6 4区 医学 Q4 ONCOLOGY
Sarah E Taylor, Phuong L Mai, Heidi Donovan, Sarah G Bell, Shannon K Rush, Robert P Edwards, Ronald J Buckanovich, Kenneth J Smith
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引用次数: 0

Abstract

Objectives: Approximately 15% of women with epithelial ovarian cancer (EOC) have a germline BRCA1/2 pathogenic variant. Genetic testing for BRCA is recommended for all EOC patients, but not routinely performed. This study estimates the cost-effectiveness of BRCA screening with primary tumor testing versus routine germline testing.

Methods: The model used literature-based probability estimates and published cost data. Effectiveness was the probability of testing completion for each strategy, providing cost per additional woman tested. A strategy was favored if it cost ≤$5000 per additional woman tested, reflecting costs of 100% receiving germline testing and 85% subsequently receiving tumor testing.

Results: In the base case, primary tumor testing costs $3057 per additional woman tested. While more costly, primary tumor testing increased efficacy 2.67-fold with an incremental cost of $1500. In sensitivity analyses, results were most sensitive to varying testing costs. Tumor testing costs ≤$5000 per additional woman tested when individually varying all parameters through clinically plausible ranges. Primary germline testing was favored in >60% of cases (base case 30%) when it occurred. In probabilistic sensitivity analysis, varying all parameters simultaneously over plausible ranges 5000 times, tumor testing cost ≤$5000 per additional woman tested in 100% of model iterations.

Conclusion: Cost effectiveness data already support BRCA1/2 screening for EOC with clear implications for cancer prevention. On the basis of this model, primary tumor testing leads to a 2.67-fold increase in testing with an incremental cost of $1500, supporting this strategy as a cost-effective way to improve BRCA testing.

上皮性卵巢癌BRCA致病变异肿瘤检测的成本-效果分析。
目的:大约15%的上皮性卵巢癌(EOC)女性患有种系BRCA1/2致病变异。建议所有EOC患者进行BRCA基因检测,但不是常规检测。本研究估计了BRCA筛查与原发肿瘤检测相比常规种系检测的成本效益。方法:该模型采用基于文献的概率估计和公开的成本数据。有效性是指每种策略完成检测的概率,提供每增加一名接受检测的妇女的成本。如果每增加一名妇女接受检测的成本≤5000美元,反映100%接受生殖系检测和85%随后接受肿瘤检测的成本,则该策略受到青睐。结果:在基本情况下,每增加一名接受检测的女性,原发肿瘤检测的费用为3057美元。虽然成本更高,但原发性肿瘤检测的疗效提高了2.67倍,增加了1500美元的成本。在敏感性分析中,结果对不同的测试成本最为敏感。当在临床合理的范围内单独改变所有参数时,每增加一名妇女的肿瘤检测费用≤5000美元。60%的病例(30%的基础病例)倾向于进行初级种系检测。在概率敏感性分析中,在合理范围内同时改变所有参数5000次,在100%的模型迭代中,每增加一名女性的肿瘤检测成本≤5000美元。结论:成本效益数据已经支持对EOC进行BRCA1/2筛查,具有明确的癌症预防意义。在此模型的基础上,原发性肿瘤检测导致检测增加2.67倍,增量成本为1500美元,支持该策略作为一种经济有效的方法来改进BRCA检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
0.00%
发文量
130
审稿时长
4-8 weeks
期刊介绍: ​​​​​​​American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists. The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles. The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.
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