Table 4.
Estimated cost effectiveness of screening and primary preventive interventions for BRCA1 and BRCA2 mutation carriers
| Intervention | Mean (SD) cost in per subject |
Incremental cost |
Mean (SD) QALYs |
Incremental QALYs |
Incremental cost/ incremental QALYs |
|---|---|---|---|---|---|
| With quality-adjusted survival in life years (QALYs) based on preference ratings of women without known high risk | |||||
| BRCA1 | |||||
| Both prophylactic surgeries | $150,986 ($3,152) | – | 16.66 (2.80) | – | – |
| Prophylactic oophorectomy | $153,396 ($2,945) | $2,410 | 18.04 (1.43) | 1.38 | $1,741 |
| Prophylactic mastectomy | $167,607 ($3,709) | $14,211 | 17.52 (1.65) | −0.52 | Dominated |
| Prophylactic oophorectomy and MRI | $170,893 ($3,393) | $17,497 | 17.63 (1.90) | −0.41 | Dominated |
| Tamoxifen | $172,353 ($3,887) | $18,957 | 17.43 (1.38) | −0.61 | Dominated |
| Mammography | $179,639 ($4,098) | $26,243 | 18.08 (0.96) | −0.40 | $681,333 |
| Mammography and MRI | $192,429 ($4,169) | $12,790 | 18.08 (1.01) | −0.01 | Dominated |
| BRCA2 | |||||
| Both prophylactic surgeries | $140,684 ($3,387) | – | 16.82 (1.60) | – | – |
| Prophylactic mastectomy | $146,505 ($3,378) | $5,821 | 17.97 (2.89) | 1.15 | Extended dominancea |
| Prophylactic oophorectomy | $147,106 ($3,586) | $6,422 | 18.22 (1.79) | 1.40 | $4,587 |
| Tamoxifen | $154,725 ($3,197) | $7,618 | 17.81 (1.47) | −0.41 | Dominated |
| Prophylactic oophorectomy and MRI | $164,039 ($3,465) | $16,932 | 17.84 (1.97) | −0.39 | Dominated |
| Mammography | $165,843 ($4,123) | $18,736 | 18.44 (1.07) | 0.21 | $88,104 |
| Mammography and MRI | $177,918 ($4,163) | $12,075 | 18.49 (1.13) | 0.49 | $247,645 |
| With quality-adjusted survival in life years (QALYs) based on preference ratings of BRCA1/2 mutation carriers | |||||
| BRCA1 | |||||
| Both prophylactic surgeries | $151,048 ($3,152) | – | 17.49 (2.83) | – | – |
| Prophylactic oophorectomy | $153,395 ($2,945) | $2,347 | 18.89 (2.83) | 1.40 | $1,677 |
| Prophylactic mastectomy | $167,559 ($3,709) | $14,163 | 17.64 (1.65) | −1.25 | Dominated |
| Prophylactic oophorectomy and MRI | $170,899 ($3,393) | $17,504 | 18.92 (1.90) | 0.02 | $736,788 |
| Tamoxifen | $172,321 ($3,887) | $1,422 | 18.22 (1,38) | −0.70 | Dominated |
| Mammography | $179,617 ($4,098) | $8,718 | 18.55 (0.96) | −0.37 | Dominated |
| Mammography and MRI | $192,418 ($4,169) | $21,519 | 18.66 (1.01) | −0.26 | Dominated |
| BRCA2 | |||||
| Both prophylactic surgeries | $140,674 ($3,387) | – | 17.68 (1.60) | – | – |
| Prophylactic mastectomy | $146,440 ($3,378) | $5,766 | 18.10 (2.89) | 0.41 | Extended dominancea |
| Prophylactic oophorectomy | $147,069 ($3,586) | $6,395 | 19.09 (1.79) | 1.41 | $4,535 |
| Tamoxifen | $154,681 ($3,197) | $7,612 | 18.70 (1.47) | −0.43 | Dominated |
| Prophylactic oophorectomy and MRI | $164,045 ($3,465) | $16,976 | 19.16 (1.97) | 0.072 | $236,867 |
| Mammography | $165,760 ($4,123) | $1,714 | 18.94 (1.07) | −0.23 | Dominated |
| Mammography and MRI | $177,934 ($4,163) | $13,888 | 19.12 (1.13) | −0.05 | Dominated |
| With survival in life years (LYs) only (no quality adjustment) | |||||
| BRCA1 | |||||
| Both prophylactic surgeries | $151,023 ($2,959) | – | 20.65 (0.53) | – | – |
| Prophylactic oophorectomy | $153,387 ($3,145) | $2,365 | 20.38 (0.51) | −0.27 | Dominated |
| Prophylactic mastectomy | $167,553 ($3,730) | $16,531 | 20.11 (0.50) | −0.54 | Dominated |
| Prophylactic oophorectomy and MRI | $170,881 ($3,380) | $19,859 | 20.48 (0.51) | −0.17 | Dominated |
| Tamoxifen | $172,327 ($3,886) | $21,304 | 19.86 (0.48) | −0.79 | Dominated |
| Mammography | $179,628 ($4,065) | $28,605 | 19.70 (0.47) | −0.95 | Dominated |
| Mammography and MRI | $192,402 ($4,184) | $41,380 | 19.83 (0.48) | −0.82 | Dominated |
| BRCA2 | |||||
| Both prophylactic surgeries | $140,688 ($3,394) | – | 20.87 (0.52) | – | – |
| Prophylactic mastectomy | $146,528 ($3,882) | $5,840 | 20.57 (0.53) | −0.30 | Dominated |
| Prophylactic oophorectomy | $147,082 ($3,810) | $6,394 | 20.56 (0.52) | −0.31 | Dominated |
| Tamoxifen | $154,738 ($3,979) | $14,049 | 20.24 (0.50) | −0.63 | Dominated |
| Prophylactic oophorectomy and MRI | $163,997 ($3,461) | $23,309 | 20.70 (0.50) | −0.17 | Dominated |
| Mammography | $165,803 ($4,175) | $25,115 | 20.03 (0.49) | −0.84 | Dominated |
| MRI and mammography | $177,929 ($5,004) | $37,240 | 20.23 (0.50) | −0.64 | Dominated |