TY - JOUR
T1 - Cost-effectiveness of routine screening for Lynch syndrome in colorectal cancer patients up to 70 years of age
AU - Leenen, Celine
AU - Goverde, Anne
AU - de Bekker - Grob, Esther
AU - Wagner, Anja
AU - Lier, Margot
AU - Spaander, Manon
AU - Bruno, Marco
AU - Tops, CM
AU - van den Ouweland, Ans
AU - Dubbink, Erik jan
AU - Kuipers, Ernst
AU - Dinjens, Winand
AU - Leerdam, M
AU - Steyerberg, Ewout
PY - 2016
Y1 - 2016
N2 - 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 (sic)4.226/LYG for screening CRC patients <= 60 years of age compared with those <= 50 years and (sic)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 (sic)7.341/LYG. All ICERs remained less than (sic)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.
AB - 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 (sic)4.226/LYG for screening CRC patients <= 60 years of age compared with those <= 50 years and (sic)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 (sic)7.341/LYG. All ICERs remained less than (sic)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.
U2 - 10.1038/gim.2015.206
DO - 10.1038/gim.2015.206
M3 - Article
C2 - 26938782
SN - 1098-3600
VL - 18
SP - 966
EP - 973
JO - Genetics in Medicine
JF - Genetics in Medicine
IS - 10
ER -
