Metastatic prostate cancer (mPCa) patients with BRCA mutations benefit from targeted treatments (e.g., olaparib). Additionally, family members of affected patients have increased risk of hereditary cancers and benefit from early detection and prevention. International guidelines recommend genetic testing in mPCa, however, the value for money of testing mPCa patients and cascade testing of blood-related family members has not been assessed. In this context we evaluated the cost-effectiveness of germline BRCA testing in mPCa patients followed by cascade testing of first-degree relatives (FDRs) of mutation carriers.
We conducted a cost-utility analysis of germline BRCA testing using two scenarios: 1) testing mPCa patients only; 2) testing mPCa patients and first-degree relatives (FDRs) of those who test positive. A semi-Markov multi-health-state transition model was constructed using a lifetime time horizon. The analyses were performed from an Australian payer perspective. Decision uncertainty was characterized using probabilistic analyses.
Compared with no testing, BRCA testing in mPCa was associated with an incremental cost of AU$3,731 and a gain of 0.014 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of AU$265,942/QALY. Extending testing to FDRs of variant positive patients resulted in an ICER of AU$16,392/QALY. Probability of cost-effectiveness at a willingness-to-pay of AU$75,000/QALY was 0% in the standalone mPCa analysis and 100% in the cascade testing analysis.
BRCA testing when performed as a standalone strategy in patients with mPCa may not be cost-effective but demonstrates significant value for money after the inclusion of cascade testing of FDRs of mutation carriers.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2024 Jul 06 [Epub ahead of print]
Srinivas Teppala, Paul Scuffham, Kim Edmunds, Matthew J Roberts, David Fairbairn, David P Smith, Lisa Horvath, Haitham Tuffaha
Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia. Electronic address: ., Centre for Applied Health Economics, Griffith University, Brisbane, QLD, Australia., Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia., UQ Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia; Department of Urology, Royal Brisbane Women's Hospital, Brisbane, QLD, Australia., Pathology Queensland, The Royal Brisbane Women's Hospital, Brisbane, QLD, Australia., The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia., Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Clinical Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.