which strategy holds most promise for women with hnpcc?

1
PharmacoEconomics & Outcomes News 559 - 9 Aug 2008 Which strategy holds most promise for women with HNPCC? Prophylactic surgery at age 40 years seems to be the most cost-effective gynaecological cancer risk-reducing strategy for women with hereditary nonpolyposis colorectal cancer (HNPCC), shows a modelling study undertaken in the US. A Markov model was constructed using the best available data to estimate costs and outcomes for a cohort of women (aged 30 years) with HNPCC at risk for endometrial and ovarian cancer. The following five strategies 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 (combined strategy). The results showed that annual screening alone would be dominated, as it would be more costly and less effective than prophylactic surgery at age 30 years [see table]. Cost effectiveness of prevention strategies in women with HNPCC Strategy Total cost QALYs ICER a ($US) No prevention 13 620 18.46 Prophylactic surgery at 18 523 18.81 13 877 age 30 years Prophylactic surgery at 19 184 18.94 5025 age 40 years Combined strategy b 25 726 18.98 194 650 Annual screening 30 912 18.66 Dominated starting at age 30 years a incremental cost-effectiveness ratio; calculated relative to the preceding strategy b annual screening from age 30 years until prophylactic surgery at age 40 years Prophylactic surgery at age 40 years would have a "favorable" ICER of $US5025/QALY, * compared with prophylactic surgery at age 30 years, say the authors. They note that while "intuitively", the combined strategy "should be the optimal prevention strategy" for these women, the substantial cost associated with this strategy "underscores the need to improve the effectiveness and decrease the lifetime costs of this intervention". Moreover, while the average gain in QALYs "may appear to be insignificant", it "represents a very large gain for those few individuals who may have died prematurely without the intervention", the authors point out. They also note that "an important caveat of the current study" is the limited availability of empirical data on patient preferences and screening in this population, "which imposes various assumptions on the model". * Costs (2006 values) were calculated from a societal perspective, and all costs and health benefits were discounted at a rate of 3% per year. Kwon JS, et al. Cost-effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome. Cancer 113: 326-335, No. 2, 15 Jul 2008 801121399 1 PharmacoEconomics & Outcomes News 9 Aug 2008 No. 559 1173-5503/10/0559-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Upload: hoangdieu

Post on 18-Mar-2017

212 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Which strategy holds most promise for women with HNPCC?

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

1

PharmacoEconomics & Outcomes News 9 Aug 2008 No. 5591173-5503/10/0559-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved