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

Leenen, Celine H.; Goverde, Angelique J.; Bekker‐Grob, Esther W. de; Wagner, Anja; Lier, Margot G F van; Spaander, Manon C.W.; Bruno, Marco J.; Tops, Sophie; Ouweland, Ans M.W. van den; Dubbink, Hendrikus J.; Kuipers, Ernst J.; Dinjens, Winand N.M.; Leerdam, Monique E. van; Steyerberg, Ewout W.

doi:10.1038/gim.2015.206

Cited by 43 publications

(94 citation statements)

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“…[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The health-care system perspective was adopted as the viewpoint of analysis in most studies. 25,[27][28][29][30][35][36][37]40,41,43,44 Four studies declared a societal perspective, but none of these included social costs. 26,31,32,39 Most economic models used were based on a decision analysis, [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]…”

Section: General Characteristics Of Studiesmentioning

confidence: 99%

“…[26][27][28][30][31][32][33][34][35][36][37][38][39]42,43 The time horizon of the analysis was not always clearly defined, although it could be deduced from the model. 29,31,40,41,44 Sensitivity analysis was performed in all economic evaluations: [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] six studies used only univariate analysis, 25,28,31,39,41,44 while nine studies performed probabilistic sensitivity analysis. 26,27,33,34,…”

Section: Quality Assessmentmentioning

confidence: 99%

“…26,27,33,34,36,38,40,42,43 Furthermore, most studies reported the range over which variables varied. [25][26][27][28][29][30][33][34][35][37][38][39][40][41][42][43][44] All economic evaluations provided an incremental analysis. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Influential parameters and basic assumptions…”

Section: Quality Assessmentmentioning

confidence: 99%

“…All studies included programs that considered CRC, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] while endometrial cancer and ovarian cancer were addressed respectively in nine [31][32][33][34]37,39,41,43,44 and in five studies. 33,34,39,41,43 Most studies focused on newly diagnosed CRC patients, [26][27][28]30,33,34,[36][37][38][39][41][42][43] but five additional different target populations were also considered. 25,29,31,…”

Section: Classification Of Ls Screening Programsmentioning

confidence: 99%

“…33,34,39,41,43 Most studies focused on newly diagnosed CRC patients, [26][27][28]30,33,34,[36][37][38][39][41][42][43] but five additional different target populations were also considered. 25,29,31,32,35,39,40,44 Regarding the diagnostic strategies covered by the evaluated programs, 14 studies included clinical criteria; [26][27][28][29][31][32][33][34][37][38][39]41,43,44 specifically, the Amsterdam criteria were used in eight studies, 28,29,[32][33][34][37][38][39] Bethesda guidelines in nine studies, 26,…”

Section: Classification Of Ls Screening Programsmentioning

confidence: 99%

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Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

Marco

D’Andrea

Panić

et al. 2018

Genetics in Medicine

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Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with agetargeted programs with lower age thresholds.Conclusion: Universal or o70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world." Genet Med advance online publication 4 January 2018Key Words: colorectal cancer; cost-effectiveness; Lynch syndrome; screening program; systematic review INTRODUCTIONLynch syndrome (LS) is the most common cause of inherited colorectal cancer (CRC), accounting for about 3% of newly diagnosed cases, and results from a mutation in one of the DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2). As LS is associated with an increased risk of colorectal, endometrial, and other cancers, it is important to identify both the probands and their family members. 1 In 2009, the Evaluation of Genomic Applications in Practice and Prevention Working Group recommended testing for LS in individuals with newly diagnosed CRC to reduce cancer morbidity and mortality in relatives. 2 The working group declared that there is a moderate certainty that this would provide moderate population benefit, but it did not recommend a specific genetic testing strategy among the several examined, nor did it deal with implementation issues. 2 Thereafter the US Department of Health and Human Services adopted the following as a Healthy People 2020 developmental objective: 3 "Increase the proportion of persons with newly diagnosed colorectal cancer who receive genetic testing to identify Lynch syndrome (or familial colorectal cancer syndromes)."Although genomic information has the potential to improve the delivery of patient-centered care through tailored preventive, diagnostic, and treatment strategies, there is a considerable gap between discoveries in genomics research and the translation of these findings into genetic services that benefit patients. 4,5 A previous study highl...

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