Cost-effectiveness of routine screening for Lynch syndrome in colorectal cancer patients up to 70 years of age

Autor: Leenen, Celine H. M., Goverde, Anne, de Bekker-Grob, Esther W., Wagner, Anja, van Lier, Margot G. F., Spaander, Manon C. W., Bruno, Marco J., Tops, Carli M., van den Ouweland, Ans M. W., Dubbink, Hendrikus J., Kuipers, Ernst J., Dinjens, Winand N. M., van Leerdam, Monique E., Steyerberg, Ewout W.
Zdroj: Genetics in Medicine; October 2016, Vol. 18 Issue: 10 p966-973, 8p
Abstrakt: 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.Genet Med 18 10, 966–973.
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