Abstract
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 mg 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 mg) 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 mg) 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 mg) 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.
| Original language | English |
|---|---|
| Pages (from-to) | 2157-2168 |
| Number of pages | 12 |
| Journal | Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology |
| Volume | 31 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2022 |
Bibliographical note
Funding Information:M.C.W. Spaander reports other support from Sysmex, Sentinel; and other support from Norgine outside the submitted work. L.M.G. Moons reports Consultant for Boston Scientific. P.J. Lugtenburg reports grants from Takeda, Servier; personal fees from Celgene, Genmab, Roche, AbbVie, Incyte; and personal fees from Regeneron outside the submitted work. G.A. Meijer reports nonfinancial support from Exact Sciences, Sysmex, Sentinel Ch.SpA, Personal Genome Diagnostics (PGDX), Hartwig Medical Foundation; grants from CZ (OWM Centrale Zorgverzekeraars groep Zorgverzekeraar u.a); and nonfinancial support from DELFi outside the submitted work; in addition, G.A. Meijer has a patent for Several pending; and GA Meijer is cofounder and board member (CSO) of colorectal cancer bioscreen BV. P. Snaeb-jornsson reports other support from MSD, Bayer; and other support from MEDtalks outside the submitted work. B. Carvalho reports a patent for Protein biomarkers for detection of colorectal cancer licensed to NL 2008707;EP13720130.7;14/396,522;NL 2010276;PCT/NL13/50316;15/444,679;EP19201973.5, a patent for Protein biomar- kers (II) for detection of colorectal cancer in stool licensed to 17172531.0;2017-009-02;2017-009-03;2017-009-04;2017-009-05;2017-009-06, and a patent for Progression markers for colorectal cancer licensed to EP19187894.1;PCT/NL2020/050482. M.E. van Leerdam reports grants from the Dutch Society of Gastroenterology and Hepatology (Maag Lever Darm Stichting (MLDS) funding project FP14-04 outside the submitted work. No disclosures were reported by the other authors.
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