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Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia

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Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. / Lim, Ka Keat; Yoon, Sook Yee; Mohd Taib, Nur Aishah et al.

In: Applied health economics and health policy, Vol. 16, No. 3, 01.06.2018, p. 395-406.

Research output: Contribution to journalArticlepeer-review

Harvard

Lim, KK, Yoon, SY, Mohd Taib, NA, Shabaruddin, FH, Dahlui, M, Woo, YL, Thong, MK, Teo, SH & Chaiyakunapruk, N 2018, 'Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia', Applied health economics and health policy, vol. 16, no. 3, pp. 395-406. https://doi.org/10.1007/s40258-018-0384-8

APA

Lim, K. K., Yoon, S. Y., Mohd Taib, N. A., Shabaruddin, F. H., Dahlui, M., Woo, Y. L., Thong, M. K., Teo, S. H., & Chaiyakunapruk, N. (2018). Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. Applied health economics and health policy, 16(3), 395-406. https://doi.org/10.1007/s40258-018-0384-8

Vancouver

Lim KK, Yoon SY, Mohd Taib NA, Shabaruddin FH, Dahlui M, Woo YL et al. Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. Applied health economics and health policy. 2018 Jun 1;16(3):395-406. https://doi.org/10.1007/s40258-018-0384-8

Author

Lim, Ka Keat ; Yoon, Sook Yee ; Mohd Taib, Nur Aishah et al. / Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia. In: Applied health economics and health policy. 2018 ; Vol. 16, No. 3. pp. 395-406.

Bibtex Download

@article{b19f2b7a4fdb43ddbe8afeaf3c3ba2f6,
title = "Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia",
abstract = "Objective: Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. Methods: We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. Results: In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. Conclusions: Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.",
author = "Lim, {Ka Keat} and Yoon, {Sook Yee} and {Mohd Taib}, {Nur Aishah} and Shabaruddin, {Fatiha Hana} and Maznah Dahlui and Woo, {Yin Ling} and Thong, {Meow Keong} and Teo, {Soo Hwang} and Nathorn Chaiyakunapruk",
year = "2018",
month = jun,
day = "1",
doi = "10.1007/s40258-018-0384-8",
language = "English",
volume = "16",
pages = "395--406",
journal = "Applied health economics and health policy",
issn = "1175-5652",
publisher = "Adis International Ltd",
number = "3",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Is BRCA Mutation Testing Cost Effective for Early Stage Breast Cancer Patients Compared to Routine Clinical Surveillance? The Case of an Upper Middle-Income Country in Asia

AU - Lim, Ka Keat

AU - Yoon, Sook Yee

AU - Mohd Taib, Nur Aishah

AU - Shabaruddin, Fatiha Hana

AU - Dahlui, Maznah

AU - Woo, Yin Ling

AU - Thong, Meow Keong

AU - Teo, Soo Hwang

AU - Chaiyakunapruk, Nathorn

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objective: Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. Methods: We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. Results: In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. Conclusions: Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.

AB - Objective: Previous studies showed that offering BRCA mutation testing to population subgroups at high risk of harbouring the mutation may be cost effective, yet no evidence is available for low- or middle-income countries (LMIC) and in Asia. We estimated the cost effectiveness of BRCA mutation testing in early-stage breast cancer patients with high pre-test probability of harbouring the mutation in Malaysia, an LMIC in Asia. Methods: We developed a decision analytic model to estimate the lifetime costs and quality-adjusted life-years (QALYs) accrued through BRCA mutation testing or routine clinical surveillance (RCS) for a hypothetical cohort of 1000 early-stage breast cancer patients aged 40 years. In the model, patients would decide whether to accept testing and to undertake risk-reducing mastectomy, oophorectomy, tamoxifen, combinations or neither. We calculated the incremental cost-effectiveness ratio (ICER) from the health system perspective. A series of sensitivity analyses were performed. Results: In the base case, testing generated 11.2 QALYs over the lifetime and cost US$4815 per patient whereas RCS generated 11.1 QALYs and cost US$4574 per patient. The ICER of US$2725/QALY was below the cost-effective thresholds. The ICER was sensitive to the discounting of cost, cost of BRCA mutation testing and utility of being risk-free, but the ICERs remained below the thresholds. Probabilistic sensitivity analysis showed that at a threshold of US$9500/QALY, 99.9% of simulations favoured BRCA mutation testing over RCS. Conclusions: Offering BRCA mutation testing to early-stage breast cancer patients identified using a locally-validated risk-assessment tool may be cost effective compared to RCS in Malaysia.

UR - http://www.scopus.com/inward/record.url?scp=85044344222&partnerID=8YFLogxK

U2 - 10.1007/s40258-018-0384-8

DO - 10.1007/s40258-018-0384-8

M3 - Article

C2 - 29572724

AN - SCOPUS:85044344222

VL - 16

SP - 395

EP - 406

JO - Applied health economics and health policy

JF - Applied health economics and health policy

SN - 1175-5652

IS - 3

ER -

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