Economic evaluation of using a genetic test to direct breast cancer chemoprevention in white women with a previous breast biopsy

LE Green, TA Dinh, DA Hinds, BL Walser… - … health economics and …, 2014 - Springer
LE Green, TA Dinh, DA Hinds, BL Walser, R Allman
Applied health economics and health policy, 2014Springer
Background Tamoxifen therapy reduces the risk of breast cancer but increases the risk of
serious adverse events including endometrial cancer and thromboembolic events.
Objectives The cost effectiveness of using a commercially available breast cancer risk
assessment test (BREVAGen™) to inform the decision of which women should undergo
chemoprevention by tamoxifen was modeled in a simulated population of women who had
undergone biopsies but had no diagnosis of cancer. Methods A continuous time, discrete …
Background Tamoxifen therapy reduces the risk of breast cancer but increases the risk of serious adverse events including endometrial cancer and thromboembolic events. Objectives The cost effectiveness of using a commercially available breast cancer risk assessment test (BREVAGen™) to inform the decision of which women should undergo chemoprevention by tamoxifen was modeled in a simulated population of women who had undergone biopsies but had no diagnosis of cancer. Methods A continuous time, discrete event, mathematical model was used to simulate a population of white women aged 40–69 years, who were at elevated risk for breast cancer because of a history of benign breast biopsy. Women were assessed for clinical risk of breast cancer using the Gail model and for genetic risk using a panel of seven common single nucleotide polymorphisms. We evaluated the cost effectiveness of using genetic risk together with clinical risk, instead of clinical risk alone, to determine eligibility for 5 years of tamoxifen therapy. In addition to breast cancer, the simulation included health states of endometrial cancer, pulmonary embolism, deep-vein thrombosis, stroke, and cataract. Estimates of costs in 2012 US dollars were based on Medicare reimbursement rates reported in the literature and utilities for modeled health states were calculated as an average of utilities reported in the literature. A 50-year time horizon was used to observe lifetime effects including survival benefits. Results For those women at intermediate risk of developing breast cancer (1.2–1.66% 5-year risk), the incremental cost-effectiveness ratio for the combined genetic and clinical risk assessment strategy over the clinical risk assessment-only strategy was US 47,000,US 44,000, and US 65,000perquality-adjustedlife-yeargained,forwomenaged40–49,50–59,and60–69years,respectively(assumingapriceofUS 945 for genetic testing). Results were sensitive to assumptions about patient adherence, utility of life while taking tamoxifen, and cost of genetic testing. Conclusions From the US payer’s perspective, the combined genetic and clinical risk assessment strategy may be a moderately cost-effective alternative to using clinical risk alone to guide chemoprevention recommendations for women at intermediate risk of developing breast cancer.
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