Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation
Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation
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DOI：
10.7326/0003-4819-144-6-200603210-00006
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发表时间：
2006-03-21
影响因子：
39.2
通讯作者：
Grann, VR
中科院分区：
文献类型：
--
作者：
Anderson, K;Jacobson, JS;Grann, VR
工作背景：对于BRCA 1或BRCA 2突变携带者，决策分析表明，预防性手术或化学预防导致更好的生存比monitoring.Objective：评估成本效益的预防策略，可用于未受影响的妇女携带一个单一的BRCA 1或BRCA 2突变与高癌症发病率。设计：马尔可夫模型与蒙特卡洛模拟和概率敏感性分析。数据来源：乳腺癌和卵巢癌的发病率和死亡率，偏好评级和来自文献的成本;监测，流行病学和最终结果（SEER）计划;和卫生保健融资管理局（现为医疗保险和医疗补助服务中心）。目标人群：35至50岁的单一BRCA 1或BRCA 2突变未受影响的携带者。时间范围：Lifetime.Perspective:卫生政策，社会。干预措施：他莫昔芬，口服避孕药，双侧输卵管卵巢切除术，乳房切除术，两种手术，或监测。结果测量：成本效益。基础病例分析结果：对于35岁的变异携带者，两次手术预防性双侧乳房切除术和卵巢切除术的成本-效果比分别为2352美元/生命年和2352美元/生命年。BRCA 2每生命年100例。经质量调整后，卵巢切除术在BRCA 1的所有其他治疗策略中占主导地位，BRCA 2的成本-效果比增加了2281美元/生命年。敏感性分析结果：干预时年龄较大使BRCA 1突变携带者预防性乳房切除术的成本-效果比增加到73755美元/生命年。不同的发病率，死亡率，成本，贴现率，和偏好有最小的影响outcome.Limitations：结果是依赖于模型的准确性assumptions.Conclusion：在此模型的基础上，最具成本效益的战略BRCA突变携带者，有和没有质量调整，卵巢切除术单独和卵巢切除术和乳房切除术，分别。
Background: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone.Objective: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance.Design: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses.Data Sources: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services).Target Population: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age.Time Horizon: Lifetime.Perspective: Health policy, societal.Interventions: Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance.Outcome Measures: Cost-effectiveness.Results of Base-Case Analysis: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of $2352 per life-year for BRCA1 and $100 per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of $2281 per life-year for BRCA2.Results of Sensitivity Analysis: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to $73 755 per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes.Limitations: Results are dependent on the accuracy of model assumptions.Conclusion: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively.