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Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country

Although BRCA1/2 genetic testing in developed countries is part of the reality for high-risk patients for hereditary breast and ovarian cancer (HBOC), the same is not true for upper-middle-income countries. For that reason, this study aimed to evaluate whether the BRCA1/2 genetic test and preventive...

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Autores principales: Lourenção, Marina, Simões Correa Galendi, Julia, Galvão, Henrique de Campos Reis, Antoniazzi, Augusto Perazzolo, Grasel, Rebeca Silveira, Carvalho, André Lopes, Mauad, Edmundo Carvalho, de Oliveira, Jorge Henrique Caldeira, Reis, Rui Manuel, Mandrik, Olena, Palmero, Edenir Inêz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309566/
https://www.ncbi.nlm.nih.gov/pubmed/35898894
http://dx.doi.org/10.3389/fonc.2022.951310
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author Lourenção, Marina
Simões Correa Galendi, Julia
Galvão, Henrique de Campos Reis
Antoniazzi, Augusto Perazzolo
Grasel, Rebeca Silveira
Carvalho, André Lopes
Mauad, Edmundo Carvalho
de Oliveira, Jorge Henrique Caldeira
Reis, Rui Manuel
Mandrik, Olena
Palmero, Edenir Inêz
author_facet Lourenção, Marina
Simões Correa Galendi, Julia
Galvão, Henrique de Campos Reis
Antoniazzi, Augusto Perazzolo
Grasel, Rebeca Silveira
Carvalho, André Lopes
Mauad, Edmundo Carvalho
de Oliveira, Jorge Henrique Caldeira
Reis, Rui Manuel
Mandrik, Olena
Palmero, Edenir Inêz
author_sort Lourenção, Marina
collection PubMed
description Although BRCA1/2 genetic testing in developed countries is part of the reality for high-risk patients for hereditary breast and ovarian cancer (HBOC), the same is not true for upper-middle-income countries. For that reason, this study aimed to evaluate whether the BRCA1/2 genetic test and preventive strategies for women at high risk for HBOC are cost-effective compared to not performing these strategies in an upper-middle-income country. Adopting a payer perspective, a Markov model with a time horizon of 70 years was built to delineate the health states for a cohort of healthy women aged 30 years that fulfilled the BRCA1/2 testing criteria according to the guidelines. Transition probabilities were calculated based on real-world data of women tested for BRCA1/2 germline mutations in a cancer reference hospital from 2011 to 2020. We analyzed 275 BRCA mutated index cases and 356 BRCA mutation carriers that were first- or second-degree relatives of the patients. Costs were based on the Brazilian public health system reimbursement values. Health state utilities were retrieved from literature. The BRCA1/2 genetic test and preventive strategies result in more quality-adjusted life years (QALYs) and costs with an incremental cost-effectiveness ratio of R$ 11,900.31 (U$ 5,504.31)/QALY. This result can represent a strong argument in favor of implementing genetic testing strategies for high-risk women even in countries with upper-middle income, considering not only the cancer prevention possibilities associated with the genetic testing but also its cost-effectiveness to the health system. These strategies are cost-effective, considering a willingness-to-pay threshold of R$ 25,000 (U$ 11,563.37)/QALY, indicating that the government should consider offering them for women at high risk for HBOC. The results were robust in deterministic and probabilistic sensitivity analyses.
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spelling pubmed-93095662022-07-26 Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country Lourenção, Marina Simões Correa Galendi, Julia Galvão, Henrique de Campos Reis Antoniazzi, Augusto Perazzolo Grasel, Rebeca Silveira Carvalho, André Lopes Mauad, Edmundo Carvalho de Oliveira, Jorge Henrique Caldeira Reis, Rui Manuel Mandrik, Olena Palmero, Edenir Inêz Front Oncol Oncology Although BRCA1/2 genetic testing in developed countries is part of the reality for high-risk patients for hereditary breast and ovarian cancer (HBOC), the same is not true for upper-middle-income countries. For that reason, this study aimed to evaluate whether the BRCA1/2 genetic test and preventive strategies for women at high risk for HBOC are cost-effective compared to not performing these strategies in an upper-middle-income country. Adopting a payer perspective, a Markov model with a time horizon of 70 years was built to delineate the health states for a cohort of healthy women aged 30 years that fulfilled the BRCA1/2 testing criteria according to the guidelines. Transition probabilities were calculated based on real-world data of women tested for BRCA1/2 germline mutations in a cancer reference hospital from 2011 to 2020. We analyzed 275 BRCA mutated index cases and 356 BRCA mutation carriers that were first- or second-degree relatives of the patients. Costs were based on the Brazilian public health system reimbursement values. Health state utilities were retrieved from literature. The BRCA1/2 genetic test and preventive strategies result in more quality-adjusted life years (QALYs) and costs with an incremental cost-effectiveness ratio of R$ 11,900.31 (U$ 5,504.31)/QALY. This result can represent a strong argument in favor of implementing genetic testing strategies for high-risk women even in countries with upper-middle income, considering not only the cancer prevention possibilities associated with the genetic testing but also its cost-effectiveness to the health system. These strategies are cost-effective, considering a willingness-to-pay threshold of R$ 25,000 (U$ 11,563.37)/QALY, indicating that the government should consider offering them for women at high risk for HBOC. The results were robust in deterministic and probabilistic sensitivity analyses. Frontiers Media S.A. 2022-07-11 /pmc/articles/PMC9309566/ /pubmed/35898894 http://dx.doi.org/10.3389/fonc.2022.951310 Text en Copyright © 2022 Lourenção, Simões Correa Galendi, Galvão, Antoniazzi, Grasel, Carvalho, Mauad, Oliveira, Reis, Mandrik and Palmero https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Lourenção, Marina
Simões Correa Galendi, Julia
Galvão, Henrique de Campos Reis
Antoniazzi, Augusto Perazzolo
Grasel, Rebeca Silveira
Carvalho, André Lopes
Mauad, Edmundo Carvalho
de Oliveira, Jorge Henrique Caldeira
Reis, Rui Manuel
Mandrik, Olena
Palmero, Edenir Inêz
Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title_full Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title_fullStr Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title_full_unstemmed Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title_short Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country
title_sort cost-effectiveness of brca 1/2 genetic test and preventive strategies: using real-world data from an upper-middle income country
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9309566/
https://www.ncbi.nlm.nih.gov/pubmed/35898894
http://dx.doi.org/10.3389/fonc.2022.951310
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