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Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases.

Abstract

BACKGROUND & AIMS

The province of Ontario, Canada, is considering immunohistochemical followed by cascade analyses of all patients who received a diagnosis of colorectal cancer (CRC) at an age younger than 70 years to identify individuals with Lynch syndrome. We evaluated the costs and benefits of testing for Lynch syndrome and determined the optimal surveillance interval for first-degree relatives (FDRs) found to have Lynch syndrome.

METHODS

We developed a patient flow diagram to determine costs and yield of immunohistochemical testing for Lynch syndrome in CRC cases and, for those found to have Lynch syndrome, their FDRs, accounting for realistic uptake. Subsequently, we used the MISCAN-colon model to compare costs and benefits of annual, biennial, and triennial surveillance in FDRs identified with Lynch syndrome vs colonoscopy screening every 10 years (usual care for individuals without a diagnosis of Lynch syndrome).

RESULTS

Testing 1000 CRC cases was estimated to identify 20 CRC index cases and 29 FDRs with Lynch syndrome at a cost of $310,274. Despite the high cost of Lynch syndrome tests, offering the FDRs with Lynch syndrome biennial colonoscopy surveillance was cost effective at $8785 per life-year gained compared with usual care, due to a substantial increase in life-years gained (+122%) and cost savings in CRC care. Triennial surveillance was more costly and less effective, and annual surveillance showed limited additional benefit compared with biennial surveillance.

CONCLUSIONS

Immunohistochemical testing for Lynch syndrome in persons younger than 70 years who received a diagnosis of colorectal cancer, and then testing first-degree relatives of those found to have Lynch syndrome, provides a good balance between costs and long-term benefits. Colonoscopy surveillance every 2 years is the optimal surveillance interval for patients with Lynch syndrome.

Authors+Show Affiliations

Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. Electronic address: e.peterse@erasmusmc.nl.Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.Strategy Division, Canadian Partnership Against Cancer, Toronto, Canada.Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada; Laboratory Medicine & Pathobiology, University of Toronto, Canada.Sunnybrook Research Institute, Toronto, Canada.Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada.Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Canada; Department of Surgery, Mount Sinai Hospital, Toronto, Canada.Prevention and Cancer Control, Cancer Care Ontario and Department of Medicine, University of Toronto, Toronto, Canada.Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Surgery, LiKaShing Knowledge Institute St. Michael's Hospital, Toronto, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31629885

Citation

Peterse, Elisabeth F P., et al. "Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 2019.
Peterse EFP, Naber SK, Daly C, et al. Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases. Clin Gastroenterol Hepatol. 2019.
Peterse, E. F. P., Naber, S. K., Daly, C., Pollett, A., Paszat, L. F., Spaander, M. C. W., ... Baxter, N. N. (2019). Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, doi:10.1016/j.cgh.2019.10.021.
Peterse EFP, et al. Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases. Clin Gastroenterol Hepatol. 2019 Oct 17; PubMed PMID: 31629885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of Active Identification and Subsequent Colonoscopy Surveillance of Lynch Syndrome Cases. AU - Peterse,Elisabeth F P, AU - Naber,Steffie K, AU - Daly,Corinne, AU - Pollett,Aaron, AU - Paszat,Lawrence F, AU - Spaander,Manon C W, AU - Aronson,Melyssa, AU - Gryfe,Robert, AU - Rabeneck,Linda, AU - Lansdorp-Vogelaar,Iris, AU - Baxter,Nancy N, Y1 - 2019/10/17/ PY - 2019/01/23/received PY - 2019/10/02/revised PY - 2019/10/11/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - colon KW - family KW - polyp KW - risk JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. N2 - BACKGROUND & AIMS: The province of Ontario, Canada, is considering immunohistochemical followed by cascade analyses of all patients who received a diagnosis of colorectal cancer (CRC) at an age younger than 70 years to identify individuals with Lynch syndrome. We evaluated the costs and benefits of testing for Lynch syndrome and determined the optimal surveillance interval for first-degree relatives (FDRs) found to have Lynch syndrome. METHODS: We developed a patient flow diagram to determine costs and yield of immunohistochemical testing for Lynch syndrome in CRC cases and, for those found to have Lynch syndrome, their FDRs, accounting for realistic uptake. Subsequently, we used the MISCAN-colon model to compare costs and benefits of annual, biennial, and triennial surveillance in FDRs identified with Lynch syndrome vs colonoscopy screening every 10 years (usual care for individuals without a diagnosis of Lynch syndrome). RESULTS: Testing 1000 CRC cases was estimated to identify 20 CRC index cases and 29 FDRs with Lynch syndrome at a cost of $310,274. Despite the high cost of Lynch syndrome tests, offering the FDRs with Lynch syndrome biennial colonoscopy surveillance was cost effective at $8785 per life-year gained compared with usual care, due to a substantial increase in life-years gained (+122%) and cost savings in CRC care. Triennial surveillance was more costly and less effective, and annual surveillance showed limited additional benefit compared with biennial surveillance. CONCLUSIONS: Immunohistochemical testing for Lynch syndrome in persons younger than 70 years who received a diagnosis of colorectal cancer, and then testing first-degree relatives of those found to have Lynch syndrome, provides a good balance between costs and long-term benefits. Colonoscopy surveillance every 2 years is the optimal surveillance interval for patients with Lynch syndrome. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/31629885/Cost-effectiveness_of_Active_Identification_and_Subsequent_Colonoscopy_Surveillance_of_Lynch_Syndrome_Cases L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(19)31165-6 DB - PRIME DP - Unbound Medicine ER -