domingo, 6 de noviembre de 2016

Cost-effectiveness of routine screening for Lynch syndrome in endometrial cancer patients up to 70years of age. - PubMed - NCBI

2016 Oct 24. pii: S0090-8258(16)31480-9. doi: 10.1016/j.ygyno.2016.10.008. [Epub ahead of print]

Cost-effectiveness of routine screening for Lynch syndrome in endometrial cancer patients up to 70years of age.

Goverde A1, Spaander MC2, van Doorn HC3, Dubbink HJ4, van den Ouweland AM5, Tops CM6, Kooi SG7, de Waard J8, Hoedemaeker RF9, Bruno MJ2, Hofstra RM5, de Bekker-Grob EW10, Dinjens WN4, Steyerberg EW10, Wagner A11; LIMO study group.

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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.