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J Gastroenterol Hepatol. 2018 Oct;33(10):1737-1744. doi: 10.1111/jgh.14154. Epub 2018 May 17.

Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population.

Author information

1
Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
2
Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
3
Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
4
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
5
Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, University of Melbourne, Parkville, Victoria, Australia.
6
Genetic Medicine and Familial Cancer Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
7
Victorian Comprehensive Cancer Centre, University of Melbourne Centre for Cancer Research, Parkville, Victoria, Australia.
8
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
9
School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
10
PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia.

Abstract

BACKGROUND AND AIM:

Individuals with Lynch syndrome (LS) are at increased risk of LS-related cancers including colorectal cancer (CRC). CRC tumor screening for mismatch repair (MMR) deficiency is recommended in Australia to identify LS, although its cost-effectiveness has not been assessed. We aim to determine the cost-effectiveness of screening individuals with CRC for LS at different age-at-diagnosis thresholds.

METHODS:

We developed a decision analysis model to estimate yield and costs of LS screening. Age-specific probabilities of LS diagnosis were based on Australian data. Two CRC tumor screening pathways were assessed (MMR immunohistochemistry followed by MLH1 methylation (MLH1-Pathway) or BRAF V600E testing (BRAF-Pathway) if MLH1 expression was lost) for four age-at-diagnosis thresholds-screening < 50, screening < 60, screening < 70, and universal screening.

RESULTS:

Per 1000 CRC cases, screening < 50 identified 5.2 LS cases and cost $A7041 per case detected in the MLH1-Pathway. Screening < 60 increased detection by 1.5 cases for an incremental cost of $A25 177 per additional case detected. Screening < 70 detected 1.6 additional cases at an incremental cost of $A40 278 per additional case detected. Compared with screening < 70, universal screening detected no additional LS cases but cost $A158 724 extra. The BRAF-Pathway identified the same number of LS cases for higher costs.

CONCLUSIONS:

The MLH1-Pathway is more cost-effective than BRAF-Pathway for all age-at-diagnosis thresholds. MMR immunohistochemistry tumor screening in individuals diagnosed with CRC aged < 70 years resulted in higher LS case detection at a reasonable cost. Further research into the yield of LS screening in CRC patients ≥ 70 years is needed to determine if universal screening is justified.

KEYWORDS:

BRAF V600E; Lynch syndrome; MLH1 methylation; colorectal cancer; cost-effectiveness; mismatch repair; screening

PMID:
29645364
PMCID:
PMC6403824
DOI:
10.1111/jgh.14154
[Indexed for MEDLINE]
Free PMC Article

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