title: Cost-effectiveness of risk-reducing surgeries in preventing hereditary breast and ovarian cancer.
abstract: OBJECTIVE
  Risk-reducing surgeries are a feasible option for mitigating the risk in individuals with inherited susceptibility to cancer, but are the procedures cost-effective in the current health-care system in Germany? This study compared the health-care costs for bilateral risk-reducing mastectomy (BRRM) and risk-reducing (bilateral) salpingo-oophorectomy (RRSO) with cancer treatment costs that could potentially be prevented.
  
  
  METHODS
  The analysis is based on interdisciplinary consultations with individuals with a high familial risk for breast and ovarian cancer at the University Breast Center for Franconia (Germany) between 2009 and 2013 (370 consultations; 44 patients with BRCA1 mutations and 26 with BRCA2 mutations). Health-care costs for risk-reducing surgeries in BRCA mutation carriers were calculated as reimbursements in the German diagnosis-related groups (DRG) hospital pricing system. These costs for the health-care system were compared with the potential cancer treatment costs that could possibly be prevented by risk-reducing surgeries.
  
  
  RESULTS
  Long-term health-care costs can be reduced by risk-reducing surgeries after genetic testing in BRCA mutation carriers. The health-care system in Germany would have saved € 136,295 if BRRM had been performed and € 791,653 if RRSO had been performed before the development of cancer in only 50% of the 70 mutation carriers seen in our center. Moreover, in patients with combined RRSO and BRRM (without breast reconstruction), one further life-year for a 40-year-old BRCA mutation carrier would cost € 2,183.
  
  
  CONCLUSIONS
  Intensive care, including risk-reducing surgeries in BRCA mutation carriers, is cost-effective from the point of view of the health-care system in Germany.
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany. Electronic address: Michael.Schrauder@uk-erlangen.de.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Schrauder
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brunel-Geuder
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Häberle
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Wunderle
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Institute of Human Genetics, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Hoyer
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Institute of Human Genetics, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Reis
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Institute of Radiology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D020022:Genetic Predisposition to Disease; D005858:Germany; D017048:Health Care Costs; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000191:economics / Q000517:prevention & control; D010052:Ovariectomy / Q000191:economics* / Q000379:methods; D000072036:Prophylactic Mastectomy / Q000191:economics*; D065286:Prophylactic Surgical Procedures / Q000191:economics; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D044767:Ubiquitin-Protein Ligases / Q000235:genetics; D055815:Young Adult
chemical_list: C111164:BRAP protein, human; D044767:Ubiquitin-Protein Ligases
keywords: BRCA; Breast cancer; Cost-effectiveness; Genetic counseling; Genetic testing; Ovarian cancer