Cost‐effectiveness of prophylactic hysterectomy in first‐degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study
| Autor: | Nikki van Leeuwen, Mengmeng Du, Iris Lansdorp-Vogelaar, Ann G. Zauber, Ewout W. Steyerberg, Elisabeth F. P. Peterse, Maaike Alblas |
|---|---|
| Přispěvatelé: | Public Health |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Cost effectiveness Colorectal cancer medicine.medical_treatment Cost-Benefit Analysis 03 medical and health sciences 0302 clinical medicine Quality of life SDG 3 - Good Health and Well-being lynch syndrome Atypia Medicine Humans Radiology Nuclear Medicine and imaging advisory committees 030212 general & internal medicine hysterectomy theoretical cost-effectiveness Research Articles RC254-282 Aged Aged 80 and over Hysterectomy business.industry Obstetrics Endometrial cancer microsimulation Neoplasms. Tumors. Oncology. Including cancer and carcinogens cost‐effectiveness Middle Aged medicine.disease Colorectal Neoplasms Hereditary Nonpolyposis Lynch syndrome United States 3. Good health Oncology 030220 oncology & carcinogenesis Cohort Quality of Life Female microsimulation model business Cancer Prevention Research Article |
| Zdroj: | Cancer Medicine, Vol 10, Iss 19, Pp 6835-6844 (2021) Cancer Medicine Cancer Medicine, 10(19), 6835-6844. WILEY Cancer Medicine, 10(19), 6835-6844. John Wiley & Sons Ltd. |
| ISSN: | 2045-7634 |
| Popis: | Background To evaluate the cost‐effectiveness of prophylactic hysterectomy (PH) in women with Lynch syndrome (LS). Methods We developed a microsimulation model incorporating the natural history for the development of hyperplasia with and without atypia into endometrial cancer (EC) based on the MISCAN‐framework. We simulated women identified as first‐degree relatives (FDR) with LS of colorectal cancer patients after universal testing for LS. We estimated costs and benefits of offering this cohort PH, accounting for reduced quality of life after PH and for having EC. Three minimum ages (30/35/40) and three maximum ages (70/75/80) were compared to no PH. Results In the absence of PH, the estimated number of EC cases was 300 per 1,000 women with LS. Total associated costs for treatment of EC were $5.9 million. Offering PH to FDRs aged 40–80 years was considered optimal. This strategy reduced the number of endometrial cancer cases to 5.4 (−98%), resulting in 516 quality‐adjusted life years (QALY) gained and increasing the costs (treatment of endometrial cancer and PH) to $15.0 million (+154%) per 1,000 women. PH from earlier ages was more costly and resulted in fewer QALYs, although this finding was sensitive to disutility for PH. Conclusions Offering PH to 40‐ to 80‐year‐old women with LS is expected to add 0.5 QALY per person at acceptable costs. Women may decide to have PH at a younger age, depending on their individual disutility for PH and premature menopause. We evaluated the cost‐effectiveness of prophylactic hysterectomy (PH) in women with Lynch syndrome (LS). Offering PH to 40–80 year old women with LS is expected to add 0.5 QALY per person at acceptable costs. Women may decide to have PH at age 35 years, depending on their individual disutility for PH and premature menopause. |
| Databáze: | OpenAIRE |
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