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- Title
The predicted impact and cost-effectiveness of systematic testing of people with incident colorectal cancer for Lynch syndrome.
- Authors
Kang, Yoon‐Jung; Killen, James; Caruana, Michael; Simms, Kate; Taylor, Natalie; Frayling, Ian M; Snowsill, Tristan; Huxley, Nicola; Coupe, Veerle MH; Hughes, Suzanne; Freeman, Victoria; Boussioutas, Alex; Trainer, Alison H; Ward, Robyn L; Mitchell, Gillian; Macrae, Finlay A; Canfell, Karen; Kang, Yoon-Jung
- Abstract
<bold>Objectives: </bold>To evaluate the health impact and cost-effectiveness of systematic testing for Lynch syndrome (LS) in people with incident colorectal cancer (CRC) in Australia.<bold>Design, Setting, Participants: </bold>We investigated the impact of LS testing strategies in a micro-simulation model (Policy1-Lynch), explicitly modelling the cost of testing all patients diagnosed with incident CRC during 2017, with detailed modelling of outcomes for patients identified as LS carriers (probands) and their at-risk relatives throughout their lifetimes. For people with confirmed LS, we modelled ongoing colonoscopic surveillance.<bold>Main Outcome Measures: </bold>Cost-effectiveness of six universal tumour testing strategies (testing for DNA mismatch repair deficiencies) and of universal germline gene panel testing of patients with incident CRC; impact on cost-effectiveness of restricting testing by age at CRC diagnosis (all ages, under 50/60/70 years) and of colonoscopic surveillance interval (one, two years).<bold>Results: </bold>The cost-effectiveness ratio of universal tumour testing strategies (annual colonoscopic surveillance, no testing age limit) compared with no testing ranged from $28 915 to $31 904/life-year saved (LYS) (indicative willingness-to-pay threshold: $30 000-$50 000/LYS). These strategies could avert 184-189 CRC deaths with an additional 30 597-31 084 colonoscopies over the lifetimes of 1000 patients with incident CRC with LS and 1420 confirmed LS carrier relatives (164-166 additional colonoscopies/death averted). The most cost-effective strategy was immunohistochemistry and BRAF V600E testing (incremental cost-effectiveness ratio [ICER], $28 915/LYS). Universal germline gene panel testing was not cost-effective compared with universal tumour testing strategies (ICER, $2.4 million/LYS). Immunohistochemistry and BRAF V600E testing was cost-effective at all age limits when paired with 2-yearly colonoscopic surveillance (ICER, $11 525-$32 153/LYS), and required 4778-15 860 additional colonoscopies to avert 46-181 CRC deaths (88-103 additional colonoscopies/death averted).<bold>Conclusions: </bold>Universal tumour testing strategies for guiding germline genetic testing of people with incident CRC for LS in Australia are likely to be cost-effective compared with no testing. Universal germline gene panel testing would not currently be cost-effective.
- Subjects
AUSTRALIA; HEREDITARY nonpolyposis colorectal cancer; DNA mismatch repair; COLORECTAL cancer; COST effectiveness; GENETIC testing; DIAGNOSIS of hereditary nonpolyposis colorectal cancer; RESEARCH; COLONOSCOPY; IMMUNOHISTOCHEMISTRY; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; COMPARATIVE studies; RESEARCH funding
- Publication
Medical Journal of Australia, 2020, Vol 212, Issue 2, p72
- ISSN
0025-729X
- Publication type
journal article
- DOI
10.5694/mja2.50356