Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review
Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy...
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| Format: | Article |
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MDPI AG
2022-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/24/6117 |
| _version_ | 1797461089577861120 |
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| author | Xia Wei Samuel Oxley Michail Sideris Ashwin Kalra Li Sun Li Yang Rosa Legood Ranjit Manchanda |
| author_facet | Xia Wei Samuel Oxley Michail Sideris Ashwin Kalra Li Sun Li Yang Rosa Legood Ranjit Manchanda |
| author_sort | Xia Wei |
| collection | DOAJ |
| description | Policymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for <i>BRCA1/2</i>, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies. |
| first_indexed | 2024-03-09T17:14:27Z |
| format | Article |
| id | doaj.art-84d8a8b57d3f463a80f6dacdabc90225 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T17:14:27Z |
| publishDate | 2022-12-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-84d8a8b57d3f463a80f6dacdabc902252023-11-24T13:46:30ZengMDPI AGCancers2072-66942022-12-011424611710.3390/cancers14246117Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic ReviewXia Wei0Samuel Oxley1Michail Sideris2Ashwin Kalra3Li Sun4Li Yang5Rosa Legood6Ranjit Manchanda7Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UKWolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UKWolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UKWolfson Institute of Population Health, CRUK Barts Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UKDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UKSchool of Public Health, Peking University, Beijing 100191, ChinaDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UKDepartment of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UKPolicymakers require robust cost-effectiveness evidence of risk-reducing-surgery (RRS) for decision making on resource allocation for breast cancer (BC)/ovarian cancer (OC)/endometrial cancer (EC) prevention. We aimed to summarise published data on the cost-effectiveness of risk-reducing mastectomy (RRM)/risk-reducing salpingo-oophorectomy (RRSO)/risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) for BC/OC prevention in intermediate/high-risk populations; hysterectomy and bilateral salpingo-oophorectomy (BSO) in Lynch syndrome women; and opportunistic bilateral salpingectomy (OBS) for OC prevention in baseline-risk populations. Major databases were searched until December 2021 following a prospective protocol (PROSPERO-CRD42022338008). Data were qualitatively synthesised following a PICO framework. Twenty two studies were included, with a reporting quality varying from 53.6% to 82.1% of the items scored in the CHEERS checklist. The incremental cost-effectiveness ratio/incremental cost-utility ratio and cost thresholds were inflated and converted to US$2020, using the original currency consumer price index (CPI) and purchasing power parities (PPP), for comparison. Eight studies concluded that RRM and/or RRSO were cost-effective compared to surveillance/no surgery for <i>BRCA1/2</i>, while RRESDO was cost-effective compared to RRSO in one study. Three studies found that hysterectomy with BSO was cost-effective compared to surveillance in Lynch syndrome women. Two studies showed that RRSO was also cost-effective at ≥4%/≥5% lifetime OC risk for pre-/post-menopausal women, respectively. Seven studies demonstrated the cost-effectiveness of OBS at hysterectomy (n = 4), laparoscopic sterilisation (n = 4) or caesarean section (n = 2). This systematic review confirms that RRS is cost-effective, while the results are context-specific, given the diversity in the target populations, health systems and model assumptions, and sensitive to the disutility, age and uptake rates associated with RRS. Additionally, RRESDO/OBS were sensitive to the uncertainty concerning the effect sizes in terms of the OC-risk reduction and long-term health impact. Our findings are relevant for policymakers/service providers and the design of future research studies.https://www.mdpi.com/2072-6694/14/24/6117risk-reducing surgerybreast cancerovarian cancerBRCAcost-effectiveness |
| spellingShingle | Xia Wei Samuel Oxley Michail Sideris Ashwin Kalra Li Sun Li Yang Rosa Legood Ranjit Manchanda Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review Cancers risk-reducing surgery breast cancer ovarian cancer BRCA cost-effectiveness |
| title | Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review |
| title_full | Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review |
| title_fullStr | Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review |
| title_full_unstemmed | Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review |
| title_short | Cost-Effectiveness of Risk-Reducing Surgery for Breast and Ovarian Cancer Prevention: A Systematic Review |
| title_sort | cost effectiveness of risk reducing surgery for breast and ovarian cancer prevention a systematic review |
| topic | risk-reducing surgery breast cancer ovarian cancer BRCA cost-effectiveness |
| url | https://www.mdpi.com/2072-6694/14/24/6117 |
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