TY - JOUR
T1 - Cost-effectiveness of routine screening for Lynch syndrome in colorectal cancer patients up to 70 years of age
AU - Leenen, Celine H.M.
AU - Goverde, Anne
AU - De Bekker-Grob, Esther W.
AU - Wagner, Anja
AU - Van Lier, Margot G.F.
AU - Spaander, Manon C.W.
AU - Bruno, Marco J.
AU - Tops, Carli M.
AU - Van Den Ouweland, Ans M.W.
AU - Dubbink, Hendrikus J.
AU - Kuipers, Ernst J.
AU - Dinjens, Winand N.M.
AU - Van Leerdam, Monique E.
AU - Steyerberg, Ewout W.
N1 - Publisher Copyright:
© 2016 American College of Medical Genetics and Genomics.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Purpose: To assess the cost-effectiveness of routine Lynch syndrome (LS) screening among colorectal cancer (CRC) patients ≤70 years of age. Methods:A population-based series of CRC patients ≤70 years of age was routinely screened for LS. We calculated life years gained (LYG) and incremental cost-effectiveness ratios (ICERs) for different age cutoffs and comparing age-targeted screening with the revised Bethesda guidelines. Results:Screening 1,117 CRC patients identified 23 LS patients, of whom 7 were ≤50 years of age, 7 were 51-60, and 9 were 61-70. Additionally, 70 LS carriers were identified among relatives (14, 42, and 14 per age category). Screening amounted to 205.9 LYG or 43.6, 118.0, and 44.3 LYG per age category. ICERs were [euro ]4.226/LYG for screening CRC patients ≤60 years of age compared with those ≤50 years and [euro ]7.051/LYG for screening CRC patients ≤70 years compared with those ≤60 years. The revised Bethesda guidelines identified 70 of 93 (75%) LS carriers. The ICER for LS screening in CRC patients ≤70 years of age compared with the revised Bethesda guidelines was [euro ]7.341/LYG. All ICERs remained less than [euro ]13.000/LYG in one-way sensitivity analyses. Conclusion: Routine LS screening by analysis of microsatellite instability, immunohistochemistry, and MLH1 hypermethylation in CRC patients ≤70 years of age is a cost-effective strategy with important clinical benefits for CRC patients and their relatives.
AB - Purpose: To assess the cost-effectiveness of routine Lynch syndrome (LS) screening among colorectal cancer (CRC) patients ≤70 years of age. Methods:A population-based series of CRC patients ≤70 years of age was routinely screened for LS. We calculated life years gained (LYG) and incremental cost-effectiveness ratios (ICERs) for different age cutoffs and comparing age-targeted screening with the revised Bethesda guidelines. Results:Screening 1,117 CRC patients identified 23 LS patients, of whom 7 were ≤50 years of age, 7 were 51-60, and 9 were 61-70. Additionally, 70 LS carriers were identified among relatives (14, 42, and 14 per age category). Screening amounted to 205.9 LYG or 43.6, 118.0, and 44.3 LYG per age category. ICERs were [euro ]4.226/LYG for screening CRC patients ≤60 years of age compared with those ≤50 years and [euro ]7.051/LYG for screening CRC patients ≤70 years compared with those ≤60 years. The revised Bethesda guidelines identified 70 of 93 (75%) LS carriers. The ICER for LS screening in CRC patients ≤70 years of age compared with the revised Bethesda guidelines was [euro ]7.341/LYG. All ICERs remained less than [euro ]13.000/LYG in one-way sensitivity analyses. Conclusion: Routine LS screening by analysis of microsatellite instability, immunohistochemistry, and MLH1 hypermethylation in CRC patients ≤70 years of age is a cost-effective strategy with important clinical benefits for CRC patients and their relatives.
KW - gastrointestinal oncology
KW - hereditary
KW - molecular diagnostics
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U2 - 10.1038/gim.2015.206
DO - 10.1038/gim.2015.206
M3 - Article
C2 - 26938782
AN - SCOPUS:84989885075
SN - 1098-3600
VL - 18
SP - 966
EP - 973
JO - Genetics in Medicine
JF - Genetics in Medicine
IS - 10
ER -
