title: Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation.
abstract: BACKGROUND
  Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation.
  
  
  METHODS
  A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%.
  
  
  CONCLUSIONS
  From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany. dirk.mueller@uk-koeln.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Danner
authors.affiliation: Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Rhiem
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
authors.affiliation: Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Engel
authors.affiliation: Department of Controlling, The University Hospital of Cologne (AöR), Kerpener Straße 62, 50937, Cologne, Germany.
authors.forename: Linda
authors.initials: L
authors.lastname: Rasche
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Borsi
authors.affiliation: Center for Hereditary Breast and Ovarian Cancer, The University Hospital of Cologne (AöR), Kerpener Straße 34, 50931, Cologne, Germany.
authors.forename: Rita
authors.initials: R
authors.lastname: Schmutzler
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000517:prevention & control; D019057:Quality-Adjusted Life Years
keywords: BRCA; Breast cancer; Cost-effectiveness; Economic modeling; Risk-reducing surgery