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2022-RA-1272-ESGO Cost-effectiveness of risk-reducing surgery for breast and ovarian cancer prevention: a systematic review
  1. Xia Wei1,
  2. Samuel Oxley2,
  3. Michail Sideris2,
  4. Ashwin Kalra2,
  5. Rosa Legood1 and
  6. Ranjit Manchanda3
  1. 1London School of Hygeine and Tropical Medicine, London, UK
  2. 2Wolfson Institute of Population Health, Queen Mary University of London, London, UK
  3. 3Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London, UK


Introduction/Background Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) are the gold standard preventative strategies for women at high-risk of breast cancer (BC)/ovarian cancer (OC). Risk-reducing early-salpingectomy followed by delayed-oophorectomy (RRESDO) is being trialled as an alternative to RRSO. Opportunistic bilateral salpingectomy (OBS) during gynaecological surgery has been proposed as a potential approach to prevent OC in general population. We performed a systematic review of the published evidence on cost-effectiveness of RRM/RRSO/RRESDO for BC/OC prevention in intermediate/high-risk women, and OBS in baseline-risk.

Methodology We searched major databases to December 2021. We included economic evaluation studies reporting on cost-effectiveness/cost-utility outcomes in women at high-risk of BC/OC undergoing RRM/RRSO/RRESDO, or baseline OC risk undergoing OBS.

Results Our search yielded 5801 citations; 22 studies were included. Eight studies concluded that RRM/RRSO individually or in combination were cost-effective compared to surveillance/no surgery for unaffected BRCA1/2 carriers, while one study found that RRESDO was cost-effective. Two studies on women at low/intermediate OC-risk specified that RRSO was cost-effective at OC lifetime risks of ≥4% (pre-menopausal) and ≥5% (post-menopausal women). These results were partially sensitive to initial age, uptake rates, cancer risk-reduction, and disutility following surgery. Four studies concluded that the addition of OBS to hysterectomy was cost-effective for OC prevention in the general population. Similarly, OBS was cost-effective as an alternative to sterilisation via laparoscopy (four studies) or at caesarean section (two studies). However, given the paucity of high-quality long-term outcome data, the uncertainty of level of risk-reduction, lack of disutility data, there remains some uncertainty around cost-effectiveness.

Conclusion This systematic review confirms that RRM/RRSO are cost-effective, and RRESDO is potentially cost-effective in women at intermediate/high risk of BC/OC in several high-income countries. Although OBS seems to be a potentially cost-effective option for OC risk-reduction, there is a need for high-quality evidence around its long-term including oncological outcomes.

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