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Cost-Effectiveness of Preventive Strategies for Women with a BRCA1 or a BRCA2 Mutation

Kristin Anderson, MPH; Judith S. Jacobson, DrPH, MBA; Daniel F. Heitjan, PhD; Joshua Graff Zivin, PhD; Dawn Hershman, MD; Alfred I. Neugut, MD, PhD; and Victor R. Grann, MD, MPH
[+] Article and Author Information

From the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.


Grant Support: By a research scholar grant from the American Cancer Society (RSGHP-03-166-01-PBP). Drs. Hershman and Neugut are the recipients of a K07 Award (CA-95597) and a K05 Award (CA89155), respectively, from the National Cancer Institute.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Victor R. Grann, MD, MPH, Mailman School of Public Health, Columbia University, Room 734, 722 West 168th Street, New York, NY 10032; e-mail, VRG2@columbia.edu.

Current Author Addresses: Ms. Anderson: Medical School Duluth, University of Minnesota, Duluth, School of Medicine 113, 1035 University Drive, Duluth, MN 55812-3031.

Drs. Jacobson and Graff Zivin: Columbia University, 722 West 168th Street, New York, NY 10032.

Dr. Heitjan: Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104-6021.

Dr. Hershman: Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, Room AP-1068, New York, NY 10032.

Drs. Neugut and Grann: Mailman School of Public Health, Columbia University, Room 734, 722 West 168th Street, New York, NY 10032.

Author Contributions: Conception and design: K. Anderson, D.F. Heitjan, J. Graff Zivin, D. Hershman, A.I. Neugut, V.R. Grann.

Analysis and interpretation of the data: K. Anderson, J.S. Jacobson, D.F. Heitjan, D. Hershman, A.I. Neugut, V.R. Grann.

Drafting of the article: K. Anderson, J.S. Jacobson, D. Hershman, V.R. Grann.

Critical revision of the article for important intellectual content: K. Anderson, J.S. Jacobson, D.F. Heitjan, J. Graff Zivin, D. Hershman, A.I. Neugut, V.R. Grann.

Final approval of the article: K. Anderson, J.S. Jacobson, D.F. Heitjan, J. Graff Zivin, D. Hershman, A.I. Neugut, V.R. Grann.

Provision of study materials or patients: K. Anderson, V.R. Grann.

Statistical expertise: K. Anderson, D.F. Heitjan, V.R. Grann.

Obtaining of funding: K. Anderson, V.R. Grann.

Administrative, technical, or logistic support: K. Anderson, V.R. Grann.

Collection and assembly of data: K. Anderson.


Ann Intern Med. 2006;144(6):397-406. doi:10.7326/0003-4819-144-6-200603210-00006
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We developed a Markov process (17) and used 25 000 Monte Carlo simulations with TreeAge DATA Pro software (TreeAge Software Inc., Williamstown, Massachusetts) to estimate the cost-effectiveness of the following preventive strategies for women with a positive test result for BRCA1 or BRCA2 mutations: chemoprevention (tamoxifen for breast cancer and oral contraceptives for ovarian cancer), prophylactic surgery (bilateral mastectomy for breast cancer and bilateral salpingo-oophorectomy for ovarian cancer; oophorectomy also reduces the risk for breast cancer), or both surgical procedures for breast and ovarian cancer, and surveillance alone. For surveillance, we assumed that women with a positive test result would follow the guidelines outlined by Burke and colleagues (18) and the National Comprehensive Cancer Network (19), which include annual mammography; breast ultrasonography, if necessary; clinical breast examinations; and semi-annual gynecology examinations, including pelvic examinations, ultrasonography, and CA-125 studies.

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Grahic Jump Location
Figure.
Preventive strategies and health states (outcomes) used in the Markov model and probabilisitic sensitivity analysis.
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Summary for Patients

The Cost-Effectiveness of Preventive Strategies for Breast and Ovarian Cancer for Women with BRCA1 or BRCA2 Mutations

The summary below is from the full report titled “Cost-Effectiveness of Preventive Strategies for Women with a BRCA1 or a BRCA2 Mutation.” It is in the 21 March 2006 issue of Annals of Internal Medicine (volume 144, pages 397-406). The authors are K. Anderson, J.S. Jacobson, D.F. Heitjan, J. Graff Zivin, D. Hershman, A.I. Neugut, and V.R. Grann.

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