Cost-Effectiveness of Targeted Genetic Testing for Breast and Ovarian Cancer: A Systematic Review |
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| Authors: | Andreas Koldehoff Marion Danner Daniele Civello Kerstin Rhiem Stephanie Stock Dirk Müller |
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| Institution: | 1. Department of Anaesthesiology, Ruhr-Universität Bochum (RUB), Bochum, Germany;2. University Hospital Schleswig-Holstein, SHARE TO CARE Team, Department of General Pediatrics, Kiel, Germany;3. Cologne Institute for Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Cologne, Germany;4. Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne (AöR), Cologne, Germany |
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| Abstract: | BackgroundTargeted genetic testing is a tool to identify women at increased risk of gynaecological cancer.ObjectiveThis systematic review evaluates the results and quality of cost-effectiveness modeling studies that assessed targeted genetic-based screen-and-treat strategies to prevent breast and ovarian cancer.MethodsUsing MEDLINE and databases of the Centre for Reviews and Dissemination, we searched for health economic modeling evaluations of targeted genetic-based screen-and-treat strategies to prevent inheritable breast and ovarian cancer (until August 2020). The incremental cost-effectiveness ratios (ICERs) were compared. Methodological variations were addressed by evaluating the model conceptualizations, the modeling techniques, parameter estimation and uncertainty, and transparency and validation of the models. Additionally, the reporting quality of each study was assessed.ResultsEighteen studies met our inclusion criteria. From a payer perspective, the ICERs of (1) BRCA screening for high-risk women without cancer ranged from dominating the no test strategy to an ICER of $21 700/quality-adjusted life years (QALY). In studies that evaluated (2) BRCA cascade screening (ie, screening of women with cancer plus their unaffected relatives) compared with no test, the ICERs were between $6500/QALY and $50 200/QALY. Compared with BRCA alone, (3) multigene testing in women without cancer had an ICER of $51 800/QALY (one study), while for (4) multigene-cascade screening the ICERs were $15 600/QALY, $56.500/QALY, and $69 600/QALY for women in the United Kingdom, Norway, and the United States, respectively (2 studies). More recently published studies showed a higher methodological and reporting quality.ConclusionsTargeted BRCA or multiple gene screening is likely to be cost-effective. Methodological variations could be decreased by the development of a reference model, which may serve as a tool for validation of present and future cost-effectiveness models. |
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| Keywords: | breast cancer cost-effectiveness genetic testing ovarian cancer |
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