gms | German Medical Science

Brücken bauen – von der Evidenz zum Patientenwohl: 19. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

08.03. - 10.03.2018, Graz

Decision-analytic evaluation of effective and cost-effective strategies for the prevention of breast and ovarian cancer in German women with BRCA-1/2 mutations

Meeting Abstract

  • author presenting/speaker Lára Hallsson - ONCOTYROL - Center for Personalized Cancer Medicine, Division of Health Technology Assessment and Bioinformatics, Innsbruck, Austria; IBE- Institute for Medical Information Processing, Biometry and Epidemiology, LMU-Ludwig-Maximilians-University, Munich, Germany; UMIT - University for Health Sciences, Medical Informatics and Technology, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Hall i. T. Austria
  • Gaby Sroczynski - Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
  • Jutta Engel - MCR-Munich Cancer Registry of the TZM-Munich Tumour Centre at the IBE-Institute for Medical Information Processing, Biometry and Epidemiology, LMU-Ludwig-Maximilians-University, Munich, Germany
  • Martin Widschwendter - UCL - University College London, Faculty of Population Health Sciences, London, UK
  • Uwe Siebert - Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Brücken bauen – von der Evidenz zum Patientenwohl. 19. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Graz, Österreich, 08.-10.03.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18ebmP5-9

doi: 10.3205/18ebm113, urn:nbn:de:0183-18ebm1130

Published: March 6, 2018

© 2018 Hallsson et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background/Objective: Women with BRCA-1 or -2 gene mutations are at increased risk for developing breast and ovarian cancer. Prophylactic bilateral mastectomy (PBM) and prophylactic bilateral salpingo-oophorectomy (PBSO) may reduce the risk for developing these cancers. Aim of this study was to systematically evaluate the long-term effectiveness and cost-effectiveness of different prevention strategies compared to intensified surveillance (IS) in German women with BRCA-1/2 mutations.

Material/Methods: We developed a decision-analytic Markov model simulating breast and ovarian cancer development in BRCA-1/2 mutation carriers. German epidemiological data from German cancer registries and the Federal Statistical Office (Destatis) as well as German economic literature data were used to populate, calibrate, and validate the model. The following different strategies were compared: (1) IS, (2) PBM at age 30, (3) PBM at age 40, (4) PBSO at age 30, (5) PBSO at age 40, (6) PBM plus PBSO at age 30 or (7) PBM plus PBSO at age 40. Assessed outcomes include reduction in incidences and mortality (in %), remaining life years (LYs), quality-adjusted life years (QALYs), total costs (in €), and discounted incremental cost-effectiveness ratios (ICER). The analysis was performed from a woman’s as well as German health care system perspective, adopting a 3% annual discount rate for costs and health effects. Comprehensive deterministic sensitivity analyses were performed to assess robustness of the results.

Results: In the base-case analysis, the combination PBM plus PBSO for 30-year old German women with BRCA1/2 mutations was the most effective strategy compared to PBM or PBSO alone or intensified surveillance, followed by PBM plus PBSO at age 40. Compared to intensified surveillance the remaining life expectancy increased by 6.2 LYs (8.6 QALYs) for PBM plus PBSO at age 30 and by 5.0 LYs (7.1 QALYs) for PBM plus PBSO at age 40. In the economic analysis, PBM plus PBSO at age 30 dominated all other strategies. In the deterministic sensitivity analyses, model results were robust against variation in all relevant parameters.

Conclusion: In conclusion, based on this decision-analysis, women with BRCA1/2 mutation in Germany would benefit from PBM plus PBSO between age 30 and 40. PBM plus PBSO at age 30 may be cost-saving compared with other prevention strategies or intensified surveillance. However, individual preferences such as a woman’s family planning situation must be considered in the final decision.