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Journal article

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 because of 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 CRC and then testing FDRs of those found to have Lynch syndrome provide 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

Peterse EFP; Naber SK; Daly C; Pollett A; Paszat LF; Spaander MCW; Aronson M; Gryfe R; Rabeneck L; Lansdorp-Vogelaar I

Journal

Clinical Gastroenterology and Hepatology, Vol. 18, No. 12, pp. 2760–2767.e12

Publisher

Elsevier

Publication Date

November 1, 2020

DOI

10.1016/j.cgh.2019.10.021

ISSN

1542-3565

Associated Experts

Nancy Baxter

Dean and Vice-President, Faculty of Health Sciences
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Labels

Fields of Research (FoR)

32 Biomedical and Clinical Sciences3202 Clinical sciences

Sustainable Development Goals (SDG)

3 Good Health and Well Being

Medical Subject Headings (MeSH)

AgedColonoscopyColorectal NeoplasmsColorectal Neoplasms, Hereditary NonpolyposisCost-Benefit AnalysisEarly Detection of CancerHumansMass Screening
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