+ Site Statistics
References:
52,654,530
Abstracts:
29,560,856
PMIDs:
28,072,755
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn

+ Translate
+ Recently Requested

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



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



Applied Health Economics and Health Policy 12(2): 203-217



Tamoxifen therapy reduces the risk of breast cancer but increases the risk of serious adverse events including endometrial cancer and thromboembolic events. 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. 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. 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$65,000 per quality-adjusted life-year gained, for women aged 40-49, 50-59, and 60-69 years, respectively (assuming a price of US$945 for genetic testing). Results were sensitive to assumptions about patient adherence, utility of life while taking tamoxifen, and cost of genetic testing. 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.

(PDF emailed within 0-6 h: $19.90)

Accession: 052771816

Download citation: RISBibTeXText

PMID: 24595521

DOI: 10.1007/s40258-014-0089-6


Related references

Evaluation of sentinel lymph node biopsy after previous breast surgery for breast cancer: GATA study. Breast 28(): 54-59, 2016

Tamoxifen for breast cancer chemoprevention: low uptake by high-risk women after evaluation of a breast lump. Annals of Family Medicine 3(3): 242-247, 2005

Comparing Mammography Abnormality Features to Genetic Variants in the Prediction of Breast Cancer in Women Recommended for Breast Biopsy. Academic Radiology 23(1): 62-69, 2015

Tamoxifen eligibility, net benefit and use for breast cancer chemoprevention among white women in the US. Cancer Epidemiology Biomarkers & Prevention 12(11 Part 2): 1314s, November, 2003

Increased promoter methylation in exfoliated breast epithelial cells in women with a previous breast biopsy. Epigenetics 6(12): 1425-1435, 2012

Sentinel node biopsy in patients with breast cancer and previous breast surgery. Revista Espanola de Medicina Nuclear 30(4): 223-228, 2011

Long-term impact of previous breast biopsy on breast cancer screening modalities. Journal Of Surgical Oncology. 59(1): 18-20, 1995

Phase II breast cancer chemoprevention study with celecoxib in women at increased risk for breast cancer. Journal of Clinical Oncology 24(18_suppl): 1010-1010, 2016

Sentinel lymph node biopsy in breast cancer patients with previous breast augmentation surgery. Breast Cancer 21(5): 624-628, 2015

The role of chemoprevention in modifying the risk of breast cancer in women with atypical breast lesions. Breast Cancer Research and Treatment 136(3): 627-633, 2013

Chemoprevention of breast cancer with selective estrogen receptor modulators: views from broadly diverse focus groups of women with elevated risk for breast cancer. Psycho-Oncology 10(6): 521-533, 2001

Acceptability and adherence in a chemoprevention trial among women at increased risk for breast cancer attending the Modena Familial Breast and Ovarian Cancer Center (Italy). Breast Journal 19(1): 10-21, 2013

Genetic variation in bone morphogenetic proteins and breast cancer risk in hispanic and non-hispanic white women: The breast cancer health disparities study. International Journal of Cancer 132(12): 2928-2939, 2013

Diagnostic genetic testing for hereditary breast and ovarian cancer in cancer patients: women's looking back on the pre-test period and a psychological evaluation. Genetic Testing 8(1): 13-21, 2004

Modeling the effect of tamoxifen chemoprevention on long-term mortality in white women at high risk of breast cancer. European Journal of Cancer Prevention 15(4): 347-352, 2006