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Cost-effectiveness of Lynch Syndrome Screening in Colorectal Cancer: Universal Germline vs Sequential Screening
Satoko Ito1, Rosa M Xicola2, Manraj Sra3
1Section of Medical Oncology and Hematology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut.
Summary
Implementing an optimized Lynch syndrome (LS) testing strategy significantly increases patient identification and is cost-effective. This approach improves quality-adjusted life expectancy compared to current standard-of-care for colorectal cancer (CRC) patients.
Area of Science:
- Oncology
- Genetics
- Health Economics
Background:
- Lynch syndrome (LS) testing in colorectal cancer (CRC) patients is recommended but faces diagnostic pathway attrition.
- This leads to missed diagnoses and preventable cancer incidence.
- A previously developed systems approach significantly improved LS identification.
Purpose of the Study:
- To evaluate the cost-effectiveness of an optimized LS testing intervention.
- Comparison against current standard-of-care and upfront germline testing for all CRC patients.
Main Methods:
- Utilized data from the Prospective Lynch Syndrome Database and SEER program.
- Developed lifetime Markov cohorts for three testing strategies: standard-of-care, optimized standard-of-care, and upfront germline testing.
- Calculated incremental cost-effectiveness ratios (ICERs) in $ per quality-adjusted life-year (QALY) from a US health system perspective.
Main Results:
- The optimized strategy accrued 11.98 QALYs at a cost of $100,980.
- Pairwise ICERs for optimized vs. standard-of-care and upfront germline testing vs. standard-of-care were $34,500/QALY and $70,300/QALY, respectively.
- Current standard-of-care was not favored in Monte Carlo simulations.
Conclusions:
- Current clinical practice for LS testing in CRC is cost-ineffective.
- Prospective interventions to increase LS testing to >75% or upfront germline testing are cost-effective.
- These strategies improve quality-adjusted life expectancy for patients.
