PMD105 - EVALUATING THE COST-EFFECTIVENESS OF SCREENING FOR THE GENETIC RISK OF THROMBOSIS DURING THE RECOMMENDATION OF COMBINED HORMONAL CONTRACEPTION FOR FIRST-TIME USERS IN SWITZERLAND

Combined hormonal contraceptives (CHCs) provide effective contraception but also increase venous thromboembolism (VTE) risk. We assessed the cost-effectiveness of a personalised screening approach in comparison to the standard of care (SoC) in Switzerland. SoC practice patterns were derived from a modified-Delphi study, while the intervention included a screening test combining clinical and genetic outcomes to determine the risk of thrombosis with the presence of a CHC. One million women with characteristics for age, BMI, family history, smoking status and nine genetic polymorphisms were simulated and progressed through a decision algorithm to determine their recommended contraception. Each woman then entered a lifetime microsimulation of the following Markov health states: no VTE, VTE, recurrent VTE, post-VTE and death. VTE risk was taken from a published algorithm, which considered clinical and genetic characteristics. Additional sequelae were derived from literature and costs calculated based on national data sources. An individual age-related utility was generated annually; event disutilities were literature-based. Outcomes of costs, life years, and quality adjusted life-years (QALYs) were discounted at 3% annually and cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) from a Swiss third-party payer perspective. The model was validated and calibrated to align with population-based studies. Additional uncertainty analyses were conducted to evaluate the impact of parameters on the ICER. In comparison to SoC, a personalised screening test led to: 0.08 fewer VTEs per 10,000 women years, 0.003 QALYs gained, additional costs of CHF 232 per person and yielded an ICER of CHF 89,888 per QALY. In probabilistic sensitivity analysis, the test had a 98% and 100% chance, respectively, of being more cost-effective at CHF 85,000 and CHF 100,000 per QALY. Introducing a genetic screening tool for younger woman during the process of recommending CHCs in Switzerland may be cost-effective at CHF 100,000 per QALY.