Abstract
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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | 6835-6844 |
| Number of pages | 10 |
| Journal | Cancer Medicine |
| Volume | 10 |
| Issue number | 19 |
| Early online date | 12 Sept 2021 |
| DOIs | |
| Publication status | Published - Oct 2021 |
Bibliographical note
Funding information:Maaike Alblas and Ewout Steyerberg received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 634570. Iris Lansdorp-Vogelaar and Ann G. Zauber received funding from the National Cancer Institute, Grant Number U01-CA199335, as part of the Cancer Intervention and Surveillance Modeling Network (CISNET). They received supplemental funding for this project titled “Microsimulation Modeling of Strategies for Identification of Lynch Syndrome Families for Endometrial Cancers” as part of the Cancer Moonshot℠ Blue Ribbon Panel initiatives. Ann G. Zauber and Mengmeng Du were also funded by P30 CA008748. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.
