The article deals the problems of using preventive surgical interventions (preventive mastectomy, preventive adnexectomy) in patients carrying BRCA mutations. The article presents and justifies economic efficiency of methods of surgical prevention compared to the observational method estimation. The most preferable tactics of management these patients offer, according to pharmacoeconomic analysis. Five models (decision trees) were developed to assess the cost of every tactics of patient management. The following health statuses were considered: no disease, primary disease, remission, and death. Based on the results of these models, pharmacoeconomic analysis was conducted to compare preventive surgical interventions with the observational method. Life years saved was the measure of effectiveness. The cost assessment was conducted for a medical facility. The modelling horizon was the age of 25–70 years. Preventive surgical interventions enabled to save 9–88 additional years of life in the cohort of 100 women with BRCA1/2 mutation compared to the observational method. Bilateral prophylactic mastectomy and preventive adnexectomy performed in the whole cohort of 50 year-old women instead of observation resulted in additional cost of 70 323 RUB for one saved year of life. Other considered approaches connected with the preventive surgical interventions were found to be more economically effective than observation. According to pharmacoeconomic analysis, the most preferable tactics of management is bilateral prophylactic mastectomy and preventive adnexectomy in the age of 40, which allow achieving greater results with fewer costs by 70 years old.
Management in healthcare