Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers

Hideko Yamauchi, Chizuko Nakagawa, Makoto Kobayashi, Yusuke Kobayashi, Toshiki Mano, Seigo Nakamura, Masami Arai

研究成果: Article

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Background: Cost-effectiveness analysis is an important aspect of healthcare, including in Japan, where preventive measures for BRCA1/2 mutation carriers are not covered by health insurance. Methods: We developed Markov models in a simulated cohort of women aged 35–70 years, and compared outcomes of surveillance with risk-reducing mastectomy (RRM) at age 35, risk-reducing salpingo-oophorectomy (RRSO) at age 45, and both (RRM&RRSO). We used breast and ovarian cancer incidences and adverse event rates from the previous studies, adjuvant chemotherapy, and hormonal therapy rates from the Hereditary Breast and Ovarian Cancer Registration 2015 in Japan, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology, and Ministry of Health, Labour and Welfare, and direct costs from St. Luke’s International Hospital and Keio University Hospital. We used previously published preference ratings of women without known high risk to adjust survival for quality of life. The discount rate was 2%. Results: Compared with surveillance, RRSO and RRM&RRSO were dominant (both cost-saving and more effective), and RRM was cost-effective in BRCA1 mutation carriers, while RRM and RRM&RRSO were dominant and RRSO was cost-effective in BRCA2. Among the four strategies including surveillance, RRM&RRSO and RRM were the most cost-effective in BRCA1 and BRCA2 mutation carriers, respectively. Conclusions: With quality adjustment, RRM, RRSO, and RRM&RRSO were all cost-effective preventive strategies in BRCA1/2 mutation carriers, with RRM&RRSO being the most cost-effective in BRCA1 and RRM in BRCA2. This result supports the inclusion of insurance coverage for BRCA mutation carriers in Japan.

元の言語English
ページ(範囲)141-150
ページ数10
ジャーナルBreast Cancer
25
発行部数2
DOI
出版物ステータスPublished - 2018 3 1

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Cost-Benefit Analysis
Mutation
Mastectomy
Ovariectomy
Costs and Cost Analysis
Japan
Ovarian Neoplasms
Hospital Societies
Breast Neoplasms
Risk Adjustment
Cancer Care Facilities
Insurance Coverage
Medical Oncology
Adjuvant Chemotherapy
Health Insurance

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Pharmacology (medical)

これを引用

Yamauchi, H., Nakagawa, C., Kobayashi, M., Kobayashi, Y., Mano, T., Nakamura, S., & Arai, M. (2018). Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers. Breast Cancer, 25(2), 141-150. https://doi.org/10.1007/s12282-017-0803-y

Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers. / Yamauchi, Hideko; Nakagawa, Chizuko; Kobayashi, Makoto; Kobayashi, Yusuke; Mano, Toshiki; Nakamura, Seigo; Arai, Masami.

:: Breast Cancer, 巻 25, 番号 2, 01.03.2018, p. 141-150.

研究成果: Article

Yamauchi, H, Nakagawa, C, Kobayashi, M, Kobayashi, Y, Mano, T, Nakamura, S & Arai, M 2018, 'Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers', Breast Cancer, 巻. 25, 番号 2, pp. 141-150. https://doi.org/10.1007/s12282-017-0803-y
Yamauchi, Hideko ; Nakagawa, Chizuko ; Kobayashi, Makoto ; Kobayashi, Yusuke ; Mano, Toshiki ; Nakamura, Seigo ; Arai, Masami. / Cost-effectiveness of surveillance and prevention strategies in BRCA1/2 mutation carriers. :: Breast Cancer. 2018 ; 巻 25, 番号 2. pp. 141-150.
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abstract = "Background: Cost-effectiveness analysis is an important aspect of healthcare, including in Japan, where preventive measures for BRCA1/2 mutation carriers are not covered by health insurance. Methods: We developed Markov models in a simulated cohort of women aged 35–70 years, and compared outcomes of surveillance with risk-reducing mastectomy (RRM) at age 35, risk-reducing salpingo-oophorectomy (RRSO) at age 45, and both (RRM&RRSO). We used breast and ovarian cancer incidences and adverse event rates from the previous studies, adjuvant chemotherapy, and hormonal therapy rates from the Hereditary Breast and Ovarian Cancer Registration 2015 in Japan, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology, and Ministry of Health, Labour and Welfare, and direct costs from St. Luke’s International Hospital and Keio University Hospital. We used previously published preference ratings of women without known high risk to adjust survival for quality of life. The discount rate was 2{\%}. Results: Compared with surveillance, RRSO and RRM&RRSO were dominant (both cost-saving and more effective), and RRM was cost-effective in BRCA1 mutation carriers, while RRM and RRM&RRSO were dominant and RRSO was cost-effective in BRCA2. Among the four strategies including surveillance, RRM&RRSO and RRM were the most cost-effective in BRCA1 and BRCA2 mutation carriers, respectively. Conclusions: With quality adjustment, RRM, RRSO, and RRM&RRSO were all cost-effective preventive strategies in BRCA1/2 mutation carriers, with RRM&RRSO being the most cost-effective in BRCA1 and RRM in BRCA2. This result supports the inclusion of insurance coverage for BRCA mutation carriers in Japan.",
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AU - Yamauchi, Hideko

AU - Nakagawa, Chizuko

AU - Kobayashi, Makoto

AU - Kobayashi, Yusuke

AU - Mano, Toshiki

AU - Nakamura, Seigo

AU - Arai, Masami

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N2 - Background: Cost-effectiveness analysis is an important aspect of healthcare, including in Japan, where preventive measures for BRCA1/2 mutation carriers are not covered by health insurance. Methods: We developed Markov models in a simulated cohort of women aged 35–70 years, and compared outcomes of surveillance with risk-reducing mastectomy (RRM) at age 35, risk-reducing salpingo-oophorectomy (RRSO) at age 45, and both (RRM&RRSO). We used breast and ovarian cancer incidences and adverse event rates from the previous studies, adjuvant chemotherapy, and hormonal therapy rates from the Hereditary Breast and Ovarian Cancer Registration 2015 in Japan, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology, and Ministry of Health, Labour and Welfare, and direct costs from St. Luke’s International Hospital and Keio University Hospital. We used previously published preference ratings of women without known high risk to adjust survival for quality of life. The discount rate was 2%. Results: Compared with surveillance, RRSO and RRM&RRSO were dominant (both cost-saving and more effective), and RRM was cost-effective in BRCA1 mutation carriers, while RRM and RRM&RRSO were dominant and RRSO was cost-effective in BRCA2. Among the four strategies including surveillance, RRM&RRSO and RRM were the most cost-effective in BRCA1 and BRCA2 mutation carriers, respectively. Conclusions: With quality adjustment, RRM, RRSO, and RRM&RRSO were all cost-effective preventive strategies in BRCA1/2 mutation carriers, with RRM&RRSO being the most cost-effective in BRCA1 and RRM in BRCA2. This result supports the inclusion of insurance coverage for BRCA mutation carriers in Japan.

AB - Background: Cost-effectiveness analysis is an important aspect of healthcare, including in Japan, where preventive measures for BRCA1/2 mutation carriers are not covered by health insurance. Methods: We developed Markov models in a simulated cohort of women aged 35–70 years, and compared outcomes of surveillance with risk-reducing mastectomy (RRM) at age 35, risk-reducing salpingo-oophorectomy (RRSO) at age 45, and both (RRM&RRSO). We used breast and ovarian cancer incidences and adverse event rates from the previous studies, adjuvant chemotherapy, and hormonal therapy rates from the Hereditary Breast and Ovarian Cancer Registration 2015 in Japan, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology, and Ministry of Health, Labour and Welfare, and direct costs from St. Luke’s International Hospital and Keio University Hospital. We used previously published preference ratings of women without known high risk to adjust survival for quality of life. The discount rate was 2%. Results: Compared with surveillance, RRSO and RRM&RRSO were dominant (both cost-saving and more effective), and RRM was cost-effective in BRCA1 mutation carriers, while RRM and RRM&RRSO were dominant and RRSO was cost-effective in BRCA2. Among the four strategies including surveillance, RRM&RRSO and RRM were the most cost-effective in BRCA1 and BRCA2 mutation carriers, respectively. Conclusions: With quality adjustment, RRM, RRSO, and RRM&RRSO were all cost-effective preventive strategies in BRCA1/2 mutation carriers, with RRM&RRSO being the most cost-effective in BRCA1 and RRM in BRCA2. This result supports the inclusion of insurance coverage for BRCA mutation carriers in Japan.

KW - BRCA1/2 mutation carrier

KW - Cost-effectiveness

KW - Prevention strategy

KW - Risk-reducing mastectomy

KW - Risk-reducing salpingo-oophorectomy

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