Cost-Effectiveness of Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors Treated with Procarbazine and/or Infradiaphragmatic Radiotherapy.

Autor:	Ykema BLM; Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands., Gini A; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands., Rigter LS; Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands., Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands., Moons LMG; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands., Bisseling TM; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands., de Boer JP; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Verbeek WHM; Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands., Lugtenburg PJ; Department of Hematology, Erasmus University, Rotterdam, the Netherlands., Janus CPM; Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands., Petersen EJ; Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands., Roesink JM; Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands., van der Maazen RWM; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands., Aleman BMP; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Meijer GA; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands., van Leeuwen FE; Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Snaebjornsson P; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Carvalho B; Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands., van Leerdam ME; Department of Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands., Lansdorp-Vogelaar I; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology [Cancer Epidemiol Biomarkers Prev] 2022 Dec 05; Vol. 31 (12), pp. 2157-2168.
DOI:	10.1158/1055-9965.EPI-22-0019
Abstrakt:	Background: Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy (IRT) and/or procarbazine have an increased risk of developing colorectal cancer. We investigated the cost-effectiveness of colorectal cancer surveillance in Dutch Hodgkin lymphoma survivors to determine the optimal surveillance strategy for different Hodgkin lymphoma subgroups. Methods: The Microsimulation Screening Analysis-Colon model was adjusted to reflect colorectal cancer and other-cause mortality risk in Hodgkin lymphoma survivors. Ninety colorectal cancer surveillance strategies were evaluated varying in starting and stopping age, interval, and modality [colonoscopy, fecal immunochemical test (FIT, OC-Sensor; cutoffs: 10/20/47 μg Hb/g feces), and multi-target stool DNA test (Cologuard)]. Analyses were also stratified per primary treatment (IRT and procarbazine or procarbazine without IRT). Colorectal cancer deaths averted (compared with no surveillance) and incremental cost-effectiveness ratios (ICER) were primary outcomes. The optimal surveillance strategy was identified assuming a willingness-to-pay threshold of €20,000 per life-years gained (LYG). Results: Overall, the optimal surveillance strategy was annual FIT (47 μg) from age 45 to 70 years, which might avert 70% of colorectal cancer deaths in Hodgkin lymphoma survivors (compared with no surveillance; ICER:€18,000/LYG). The optimal surveillance strategy in Hodgkin lymphoma survivors treated with procarbazine without IRT was biennial FIT (47 μg) from age 45 to 70 years (colorectal cancer mortality averted 56%; ICER:€15,000/LYG), and when treated with IRT and procarbazine, annual FIT (47 μg) surveillance from age 40 to 70 was most cost-effective (colorectal cancer mortality averted 75%; ICER:€13,000/LYG). Conclusions: Colorectal cancer surveillance in Hodgkin lymphoma survivors is cost-effective and should commence earlier than screening occurs in population screening programs. For all subgroups, FIT surveillance was the most cost-effective strategy. Impact: Colorectal cancer surveillance should be implemented in Hodgkin lymphoma survivors. (©2022 The Authors; Published by the American Association for Cancer Research.)
Databáze:	MEDLINE
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