Anne Goverde1, Manon Cw Spaander2, Helena C van Doorn3, Hendrikus J Dubbink4, Ans Mw van den Ouweland5, Carli M Tops6, Sjarlot G Kooi7, Judith de Waard8, Robert F Hoedemaeker9, Marco J Bruno2, Robert Mw Hofstra5, Esther W de Bekker-Grob10, Winand Nm Dinjens4, Ewout W Steyerberg10, Anja Wagner11. 1. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 3. Department of Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 4. Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 5. Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 6. Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. 7. Department of Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands. 8. Department of Gynaecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands. 9. Pathology Laboratory Pathan, Rotterdam, The Netherlands. 10. Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 11. Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: a.wagner@erasmusmc.nl.
Abstract
PURPOSE: To assess cost-effectiveness of routine screening for Lynch Syndrome (LS) in endometrial cancer (EC) patients ≤70years of age. METHODS: Consecutive EC patients ≤70years of age were screened for LS by analysis of microsatellite instability, immunohistochemistry and MLH1 hypermethylation. Costs and health benefit in life years gained (LYG) included surveillance for LS carriers among EC patients and relatives. We calculated incremental cost-effectiveness ratios (ICERs) comparing LS screening among EC patients ≤70years with ≤50years and the revised Bethesda guidelines. RESULTS: Screening for LS in 179 EC patients identified 7 LS carriers; 1 was ≤50 and 6 were 51-70years. Per age category 18 and 9 relatives were identified as LS carrier. Screening resulted in 74,7 LYG (45,4 and 29,3 LYG per age category). The ICER for LS screening in EC patients ≤70 compared with ≤50years was €5,252/LYG. The revised Bethesda guidelines missed 4/7 (57%) LS carriers among EC patients. The ICER for LS screening in EC patients ≤70years of age compared with the revised Bethesda guidelines was €6,668/LYG. Both ICERs remained <€16,000/LYG in sensitivity analyses. CONCLUSION: Routine LS screening in EC patients ≤70years is a cost-effective strategy, allowing colorectal cancer prevention in EC patients and their relatives.
PURPOSE: To assess cost-effectiveness of routine screening for Lynch Syndrome (LS) in endometrial cancer (EC) patients ≤70years of age. METHODS: Consecutive EC patients ≤70years of age were screened for LS by analysis of microsatellite instability, immunohistochemistry and MLH1 hypermethylation. Costs and health benefit in life years gained (LYG) included surveillance for LS carriers among EC patients and relatives. We calculated incremental cost-effectiveness ratios (ICERs) comparing LS screening among EC patients ≤70years with ≤50years and the revised Bethesda guidelines. RESULTS: Screening for LS in 179 EC patients identified 7 LS carriers; 1 was ≤50 and 6 were 51-70years. Per age category 18 and 9 relatives were identified as LS carrier. Screening resulted in 74,7 LYG (45,4 and 29,3 LYG per age category). The ICER for LS screening in EC patients ≤70 compared with ≤50years was €5,252/LYG. The revised Bethesda guidelines missed 4/7 (57%) LS carriers among EC patients. The ICER for LS screening in EC patients ≤70years of age compared with the revised Bethesda guidelines was €6,668/LYG. Both ICERs remained <€16,000/LYG in sensitivity analyses. CONCLUSION: Routine LS screening in EC patients ≤70years is a cost-effective strategy, allowing colorectal cancer prevention in EC patients and their relatives.
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