Cost-Utility of Early Breast Cancer Surveillance in Survivors of Thoracic Radiation-Treated Adolescent Hodgkin’s Lymphoma
Menée dans un contexte américain, cette étude analyse le rapport coût-efficacité de 8 stratégies de surveillance dès l'âge de 25 ans chez des patientes ayant survécu à un lymphome de Hodgkin (traité à l'âge de 15 ans) et présentant un risque élévé de développer un cancer du sein
Background : Adolescent females treated for Hodgkin’s Lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children’s Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25. Methods : A discrete event simulation model was used to simulate the life histories of a cohort of 500,000 25-year-old females treated for HL at age 15. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), healthcare costs, and the relative cost-utility (incremental cost-utility ratio, ICUR) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled model uncertainty evaluation. A publicly-funded healthcare payer perspective was adopted. Results : Costs across the eight screening strategies ranged from $32,643 to $43,739, while QALYs ranged from 24.419-24.480. In an incremental cost effectiveness analysis, annual mammography beginning at age 25 was associated with an ICUR of $43,000/QALY gained, annual MRI beginning at age 25 with a switch to annual mammography at age 50 had an ICUR of $148,000/QALY and annual MRI beginning at age 25 had an ICUR of $227,222/QALY. Between all assessed surveillance strategies, the differences in life expectancy were small. Conclusions : Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high-risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.