Highlights
- •Women with high-grade serous ovarian cancer (HGSC) have a 20% risk of carrying a BRCA mutation.
- •Many women with HGSC are untested for BRCA mutations, and their first-degree relatives may be ineligible for BRCA testing.
- •BRCA testing for first-degree relatives of women with HGSC is cost-effective when BRCA status is unknown.
- •BRCA testing with subsequent risk-reducing surgery is more effective and less costly than surgery alone.
Abstract
Background
Women with high-grade serous ovarian cancer (HGSC) have a 20% chance of carrying a
BRCA1 or 2 mutation. Not all undergo genetic testing, and there is a large legacy
group of untested patients. Their female first-degree relatives (FDR) may not qualify
for testing unless they have specific ethnicity, or personal/family cancer history.
We conducted a cost-effectiveness analysis to evaluate risk-reducing strategies for
these FDR who are ineligible for testing.
Methods
A Markov Monte Carlo simulation model estimated the costs and benefits of 3 strategies
for female FDR of HGSC patients whose BRCA status is unknown: (1) no BRCA testing;
(2) universal BRCA testing, followed by risk-reducing bilateral salpingo-oophorectomy
(RRBSO) for mutation carriers; (3) universal RRBSO, without BRCA testing. Effectiveness
was estimated in quality-adjusted life year (QALY) gains over a 50-year time horizon.
Sensitivity analyses accounted for uncertainty around various parameters.
Results
Universal BRCA testing for female FDR of women with HGSC yielded a higher average
QALY gain at acceptable cost compared to no BRCA testing, with an incremental cost-effectiveness
ratio of $7888 per QALY. Universal BRCA testing was more effective and less costly
than universal RRBSO (19.20 QALYs vs. 18.52 QALYs, and $10,135 vs. $14,231, respectively).
Results were stable over wide ranges of plausible costs and estimates. Compliance
with hormone replacement therapy had to exceed 79.3% for universal RRBSO to be the
most effective strategy.
Conclusion
BRCA mutation testing should be offered to all female first-degree relatives of women
with high-grade serous ovarian cancer when BRCA mutation status is unknown.
Keywords
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Article info
Publication history
Accepted:
October 15,
2018
Received in revised form:
September 25,
2018
Received:
July 18,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
