PharmacoEconomics & Outcomes News 559 - 9 Aug 2008
Which strategy holds mostpromise for women with HNPCC?Prophylactic surgery at age 40 years seems to be the
most cost-effective gynaecological cancer risk-reducingstrategy for women with hereditary nonpolyposiscolorectal cancer (HNPCC), shows a modelling studyundertaken in the US.
A Markov model was constructed using the bestavailable data to estimate costs and outcomes for acohort of women (aged 30 years) with HNPCC at risk forendometrial and ovarian cancer. The following fivestrategies were assessed:• no prevention (reference strategy)• prophylactic surgery (hysterectomy with bilateral
salpingo-oophorectomy) at age 30 years• prophylactic surgery at age 40 years• annual screening from age 30 years alone• annual screening from age 30 years until
prophylactic surgery at age 40 years (combinedstrategy).
The results showed that annual screening alonewould be dominated, as it would be more costly and lesseffective than prophylactic surgery at age 30 years[see table].
Cost effectiveness of prevention strategies inwomen with HNPCCStrategy Total cost QALYs ICERa
($US)
No prevention 13 620 18.46Prophylactic surgery at 18 523 18.81 13 877age 30 years
Prophylactic surgery at 19 184 18.94 5025age 40 years
Combined strategyb 25 726 18.98 194 650Annual screening 30 912 18.66 Dominatedstarting at age30 years
a incremental cost-effectiveness ratio; calculated relative to thepreceding strategyb annual screening from age 30 years until prophylactic surgery at age40 years
Prophylactic surgery at age 40 years would have a"favorable" ICER of $US5025/QALY,* compared withprophylactic surgery at age 30 years, say the authors.They note that while "intuitively", the combined strategy"should be the optimal prevention strategy" for thesewomen, the substantial cost associated with thisstrategy "underscores the need to improve theeffectiveness and decrease the lifetime costs of thisintervention".
Moreover, while the average gain in QALYs "mayappear to be insignificant", it "represents a very large gainfor those few individuals who may have died prematurelywithout the intervention", the authors point out. Theyalso note that "an important caveat of the current study"is the limited availability of empirical data on patientpreferences and screening in this population, "whichimposes various assumptions on the model".* Costs (2006 values) were calculated from a societal perspective, andall costs and health benefits were discounted at a rate of 3% per year.
Kwon JS, et al. Cost-effectiveness analysis of prevention strategies for gynecologiccancers in Lynch syndrome. Cancer 113: 326-335, No. 2, 15 Jul 2008 801121399
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PharmacoEconomics & Outcomes News 9 Aug 2008 No. 5591173-5503/10/0559-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
