Cost-Effectiveness Analysis of a Low-Fat Diet in the Prevention of Breast and Ovarian Cancer

Abstract

Background Results of the Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHI-DM) suggest that a low-fat diet may be associated with beneficial health outcomes for specific groups of women. Objective The objective is to assess how cost-effective the WHI-DM would be if implemented as a public health intervention and under the sponsorship of private health insurers and Medicare. Breast and ovarian cancers are the health outcomes of interest. Participants Two groups of WHI-DM participants form the target population for this analysis: participants consuming >36.8% of energy from fat at baseline, and participants at high risk for breast cancer with 32% or more of energy from fat at baseline. Methods This study uses Markov cohort modeling, following societal and health care payer perspectives, with Monte Carlo simulations and one-way sensitivity analyses. WHI-DM records, nationally representative prices, and published estimates of medical care costs were the sources of cost information. Simulations were performed for hypothetical cohorts of women aged 50, 55, 60, 65, or 70 years at the beginning of the intervention. Effectiveness was estimated by quality-adjusted life years (QALYs) and the main outcome measure was the incremental cost-effectiveness ratio (ICER). Results Following the societal perspective, the ICERs for the 50-year old cohort are $13,773/QALY (95% confidence interval $7,482 to $20,916) for women consuming >36.8% of energy from fat at baseline and $10,544/QALY ($2,096 to $23,673) for women at high risk for breast cancer. The comparable ICER from a private health care payer perspective is $66,059/QALY ($30,155 to $121,087) and from a Medicare perspective, it is $15,051/QALY ($6,565 to $25,105). Conclusions The WHI-DM is a cost-effective strategy for the prevention of breast and ovarian cancers in the target population, from both societal and Medicare perspectives. Private health care payers have a relative short time-frame to realize a return on investment, since after age 65 years the financial benefits associated with the prevention program would accrue to Medicare. For this reason, the intervention is not cost-effective from a private health care payer perspective.

Cost-Effectiveness of Lifestyle-Related Interventions for the Primary Prevention of Breast Cancer: A Rapid Review

“…Table 1 presents the quality of the six studies included, ranging from 74 to 89%. Bós et al ranked the highest score for very good quality, followed by Frew et al and Peels et al (37,39,40), while the lowest score was found for Annemans et al (36). All studies underperformed in category 2 ("data collection").…”

“…The median cost-effectiveness (in 2018 USD) reported in the four studies, of which ICER/QALY was estimated and for which the price-year was available, was $24,973 (37,(39)(40)(41). From a societal perspective, 80% of the interventions had a ratio below $50,000 WTP threshold (as shown in Table 2).…”

“…Breast cancer was the primary focus of prevention, along with ovarian cancer only, in Bós et al who analyzed the costeffectiveness of a low-fat diet on these two cancers (37). In five of the studies, breast cancer was among other non-communicable diseases (NCDs), such as coronary heart disease, diabetes, stroke, and colorectal cancer, targeted by the primary prevention interventions, and it was included in the cost-effectiveness model (Supplementary Table 2).…”

“…The adult populations with ages from 16 to 30, as well as the populations aged 50 and above, were the most commonly targeted groups (36,38,39,41). However, menopausal women were targeted for the primary prevention of breast and ovarian cancer ( Supplementary Table 2) (37,40). The PA strategies compared no intervention or "usual care" to one or up to six strategies in one study (41).…”

Adverse Events Associated With Complementary and Alternative Medicine Use in Ovarian Cancer Patients

“…In addition to a lack of randomized controlled trials (RCTs) in humans, adequate reporting of safety in publications of randomized controlled trials is a pre-requisite for accurate and comprehensive profile evaluation of conventional as well as complementary and alternative medicine (CAM) treatments. An evaluation of safety reporting in the reports of CAM RCTs across 15 different CAM interventions demonstrated that the reporting of harms was largely inadequate 46 . The reasons for inadequate reporting are currently unclear.…”