METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
方法:我们使用两种情况进行了种系BRCA测试的成本效用分析:1)仅测试mPCa患者;2)测试mPCa患者和测试阳性患者的一级亲属(FDRs)。使用生命周期时间范围构建了半马尔可夫多健康状态转移模型。这些分析是从澳大利亚付款人的角度进行的。使用概率分析来表征决策不确定性。
结果:与未测试相比,mPCa中的BRCA测试与3,731澳元的增量成本和0.014质量调整寿命年(QALYs)的收益相关,导致增量成本效益比(ICER)为265,942澳元/QALY。将测试扩展到变异阳性患者的FDR导致ICER为AU$16,392/QALY。在独立mPCa分析中,愿意支付$75,000/QALY的成本效益概率为0%,在级联测试分析中为100%。
结论:BRCA检测在mPCa患者中作为独立策略进行时可能不具成本效益,但在纳入突变携带者FDRs级联检测后显示出显著的资金价值。