Analisi di minimizzazione dei costi di una strategia di test preventivo per le familiari di pazienti con carcinoma dell’ovaio BRCA mutato

Abstract

Purpose:: This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia.

Methods:: A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed.

Results:: Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed.

Conclusions:: Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values.

Fig. 1-

Albero decisionale. BC = breast cancer; OC = ovarian cancer Fonte: adattato da Manchanda et al., 2014 (12)

Fig. 2 -

Distribuzione della popolazione rispetto all’applicazione del test genetico versus strategia di attesa. BC = breast cancer; OC = ovarian cancer Fonte: nostra elaborazione

Fig. 3 -

Curva di probabilità ­costo-efficacia. BC = breast cancer; OC = ovarian cancer Fonte: nostra elaborazione