ORCID Profile
0000-0003-3245-8895
Current Organisations
The Daffodil Centre
,
University of Melbourne
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Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1038/GIM.2017.255
Abstract: To review the evidence for the effectiveness and cost-effectiveness of cancer risk management interventions for BRCA carriers. Comparative effectiveness and cost-effectiveness analyses were identified by searching scientific and health economic databases. Eligible studies modeled the impact of a cancer risk management intervention in BRCA carriers on life expectancy (LE), cancer incidence, or quality-adjusted life years (QALYs), with or without costs. Twenty-six economic evaluations and eight comparative effectiveness analyses were included. Combined risk-reducing salpingo-oophorectomy and prophylactic mastectomy resulted in the greatest LE and was cost-effective in most analyses. Despite leading to increased LE and QALYs, combined mammography and breast magnetic resonance imaging (MRI) was less likely to be cost-effective than either mammography or MRI alone, particularly for women over 50 and BRCA2 carriers. Variation in patient compliance to risk management interventions was incorporated in 11/34 studies with the remaining analyses assuming 100% adherence. Prophylactic surgery and intensive breast screening are effective and cost-effective in models of BRCA carrier risk management. Findings were based predominantly on assuming perfect adherence to recommendations without assessment of the health-care resource use and costs related to engaging patients and maximizing compliance, meaning the real-world impact on clinical outcomes and resource use remains unclear.
Publisher: Wiley
Date: 10-2018
DOI: 10.1111/IMJ.14058
Abstract: Federal funding for germline genetic testing in hereditary breast and ovarian cancer (HBOC) was recently introduced. Germline testing for HBOC under Medicare Benefits Schedule items 73296/73297 can be requested by any specialist, whereas the previous state- and territory-funded testing was limited to those operating within a familial cancer service. The impact of this decentralisation of HBOC testing on health and economic outcomes is uncertain, primarily as it has potential to significantly disrupt the clinical framework that generated the evidence used to justify clinical implementation of the Medicare Benefits Schedules.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JVAL.2019.03.008
Abstract: To develop a validated model for evaluating the real-world effectiveness of long-term clinical management strategies for women with germline BRCA1 or BRCA2 pathogenic variants. A microsimulation model was developed that included a BRCA-specific natural history for breast and ovarian cancer, a clinical framework for carrier follow-up, and cancer risk management strategies (breast screening, risk-reducing mastectomy, and bilateral salpingo-oophorectomy). Adherence rates and outcomes for breast screening and risk-reducing surgery were obtained from BRCA carriers seen through a familial cancer service in Melbourne, Australia. The model was assessed for internal and external validity. The model was used to compare women perfectly adhering to screening recommendations versus actual adherence of the clinical cohort. The model accurately predicted cancer incidence, pathology, and mortality. Using actual adherence for breast screening resulted in additional breast cancer deaths (per 1000 women: BRCA1, 2.7 BRCA2, 1.6) compared with perfect screening adherence. This decreased average life expectancy by 0.30 life-years for BRCA1 and 0.07 life-years for BRCA2. When carriers had access to risk-reducing mastectomy, the benefit from improved screening adherence was not significant. The developed model is a good descriptor of BRCA carriers' lifetime trajectory and its modification by use of risk management strategies alone or in combination. Evaluations of breast screening in BRCA carriers may overestimate the benefits of screening programs unless adherence is considered. By incorporating real-world clinical practice and patient behavior, this model can assist in developing clinical services and improving clinical outcomes for carriers.
Publisher: Public Library of Science (PLoS)
Date: 25-06-2015
Publisher: Elsevier BV
Date: 09-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 18-08-2018
Publisher: Springer Science and Business Media LLC
Date: 08-04-2019
Publisher: American Medical Association (AMA)
Date: 09-09-2021
Publisher: Public Library of Science (PLoS)
Date: 29-01-2014
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 09-2019
Publisher: Wiley
Date: 2014
DOI: 10.3402/JEV.V3.23784
No related grants have been discovered for Lara Petelin.