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Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers.

Publication ,  Journal Article
Havrilesky, LJ; Moss, HA; Chino, J; Myers, ER; Kauff, ND
Published in: Gynecol Oncol
June 2017

OBJECTIVE: To estimate the survival benefit and cost-effectiveness of performing hysterectomy during risk-reducing salpingo-oophorectomy (RRSO) for BRCA1 mutation carriers. METHODS: Based on a recent prospective cohort study indicating an elevated incidence of serous/serous-like uterine cancers among BRCA1 mutation carriers, we constructed a modified Markov decision model from a payer perspective to inform decisions about performance of hysterectomy during RRSO at age 40. We assumed patients had previously undergone a risk-reducing mastectomy and had a residual risk of death from breast or ovarian cancer. Disease-specific survival, age-adjusted competing hysterectomy rates, and deaths from other causes were incorporated. Costs of risk-reducing surgery, competing hysterectomy, and care for serous/serous-like uterine cancer were included. RESULTS: A 40year old woman who undergoes RRSO+Hysterectomy gains 4.9 additional months of overall survival (40.38 versus 39.97 undiscounted years) compared to RRSO alone. The lifetime probabilities of developing or dying from serous/serous-like uterine cancer in the RRSO group are 3.5% and 2%, respectively. The RRSO alone strategy has an average cost of $9013 compared to $8803 for RRSO+Hysterectomy, and is dominated (less effective and more costly) when compared to RRSO+Hysterectomy. In an alternative analysis, delayed hysterectomy remains a cost-effective prevention strategy with an ICER of less than $100,000/year for up to 25years following RRSO at age 40. CONCLUSIONS: The addition of hysterectomy to RRSO in a 40year old BRCA1 mutation carrier results in a mean gain of 4.9 additional months of life and is cost-effective.

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

June 2017

Volume

145

Issue

3

Start / End Page

549 / 554

Location

United States

Related Subject Headings

  • Uterine Neoplasms
  • United States
  • Prophylactic Surgical Procedures
  • Ovariectomy
  • Oncology & Carcinogenesis
  • Models, Statistical
  • Middle Aged
  • Markov Chains
  • Hysterectomy
  • Humans
 

Citation

APA
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ICMJE
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Havrilesky, L. J., Moss, H. A., Chino, J., Myers, E. R., & Kauff, N. D. (2017). Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers. Gynecol Oncol, 145(3), 549–554. https://doi.org/10.1016/j.ygyno.2017.03.025
Havrilesky, Laura J., Haley A. Moss, Junzo Chino, Evan R. Myers, and Noah D. Kauff. “Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers.Gynecol Oncol 145, no. 3 (June 2017): 549–54. https://doi.org/10.1016/j.ygyno.2017.03.025.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

June 2017

Volume

145

Issue

3

Start / End Page

549 / 554

Location

United States

Related Subject Headings

  • Uterine Neoplasms
  • United States
  • Prophylactic Surgical Procedures
  • Ovariectomy
  • Oncology & Carcinogenesis
  • Models, Statistical
  • Middle Aged
  • Markov Chains
  • Hysterectomy
  • Humans