Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population
© 2018 The Authors Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd Background and Aim: Individuals with Lynch syndrome (LS) are at increased risk of LS-related cancers including colorectal cancer...
| Main Authors: | , , , , , , , |
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| Format: | Journal Article |
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Wiley-Blackwell Publishing Asia
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/71547 |
| _version_ | 1848762508945391616 |
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| author | Cenin, Dayna Naber, S. Lansdorp-Vogelaar, Iris Jenkins, M. Buchanan, D. Preen, D. Ee, H. O'Leary, Peter |
| author_facet | Cenin, Dayna Naber, S. Lansdorp-Vogelaar, Iris Jenkins, M. Buchanan, D. Preen, D. Ee, H. O'Leary, Peter |
| author_sort | Cenin, Dayna |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2018 The Authors Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd Background and Aim: Individuals with Lynch syndrome (LS) are at increased risk of LS-related cancers including colorectal cancer (CRC). CRC tumor screening for mismatch repair (MMR) deficiency is recommended in Australia to identify LS, although its cost-effectiveness has not been assessed. We aim to determine the cost-effectiveness of screening individuals with CRC for LS at different age-at-diagnosis thresholds. Methods: We developed a decision analysis model to estimate yield and costs of LS screening. Age-specific probabilities of LS diagnosis were based on Australian data. Two CRC tumor screening pathways were assessed (MMR immunohistochemistry followed by MLH1 methylation (MLH1-Pathway) or BRAF V600E testing (BRAF-Pathway) if MLH1 expression was lost) for four age-at-diagnosis thresholds—screening < 50, screening < 60, screening < 70, and universal screening. Results: Per 1000 CRC cases, screening < 50 identified 5.2 LS cases and cost $A7041 per case detected in the MLH1-Pathway. Screening < 60 increased detection by 1.5 cases for an incremental cost of $A25 177 per additional case detected. Screening < 70 detected 1.6 additional cases at an incremental cost of $A40 278 per additional case detected. Compared with screening < 70, universal screening detected no additional LS cases but cost $A158 724 extra. The BRAF-Pathway identified the same number of LS cases for higher costs. Conclusions: The MLH1-Pathway is more cost-effective than BRAF-Pathway for all age-at-diagnosis thresholds. MMR immunohistochemistry tumor screening in individuals diagnosed with CRC aged < 70 years resulted in higher LS case detection at a reasonable cost. Further research into the yield of LS screening in CRC patients = 70 years is needed to determine if universal screening is justified. |
| first_indexed | 2025-11-14T10:48:41Z |
| format | Journal Article |
| id | curtin-20.500.11937-71547 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:48:41Z |
| publishDate | 2018 |
| publisher | Wiley-Blackwell Publishing Asia |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-715472018-12-13T09:32:28Z Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population Cenin, Dayna Naber, S. Lansdorp-Vogelaar, Iris Jenkins, M. Buchanan, D. Preen, D. Ee, H. O'Leary, Peter © 2018 The Authors Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd Background and Aim: Individuals with Lynch syndrome (LS) are at increased risk of LS-related cancers including colorectal cancer (CRC). CRC tumor screening for mismatch repair (MMR) deficiency is recommended in Australia to identify LS, although its cost-effectiveness has not been assessed. We aim to determine the cost-effectiveness of screening individuals with CRC for LS at different age-at-diagnosis thresholds. Methods: We developed a decision analysis model to estimate yield and costs of LS screening. Age-specific probabilities of LS diagnosis were based on Australian data. Two CRC tumor screening pathways were assessed (MMR immunohistochemistry followed by MLH1 methylation (MLH1-Pathway) or BRAF V600E testing (BRAF-Pathway) if MLH1 expression was lost) for four age-at-diagnosis thresholds—screening < 50, screening < 60, screening < 70, and universal screening. Results: Per 1000 CRC cases, screening < 50 identified 5.2 LS cases and cost $A7041 per case detected in the MLH1-Pathway. Screening < 60 increased detection by 1.5 cases for an incremental cost of $A25 177 per additional case detected. Screening < 70 detected 1.6 additional cases at an incremental cost of $A40 278 per additional case detected. Compared with screening < 70, universal screening detected no additional LS cases but cost $A158 724 extra. The BRAF-Pathway identified the same number of LS cases for higher costs. Conclusions: The MLH1-Pathway is more cost-effective than BRAF-Pathway for all age-at-diagnosis thresholds. MMR immunohistochemistry tumor screening in individuals diagnosed with CRC aged < 70 years resulted in higher LS case detection at a reasonable cost. Further research into the yield of LS screening in CRC patients = 70 years is needed to determine if universal screening is justified. 2018 Journal Article http://hdl.handle.net/20.500.11937/71547 10.1111/jgh.14154 Wiley-Blackwell Publishing Asia restricted |
| spellingShingle | Cenin, Dayna Naber, S. Lansdorp-Vogelaar, Iris Jenkins, M. Buchanan, D. Preen, D. Ee, H. O'Leary, Peter Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title | Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title_full | Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title_fullStr | Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title_full_unstemmed | Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title_short | Costs and outcomes of Lynch syndrome screening in the Australian colorectal cancer population |
| title_sort | costs and outcomes of lynch syndrome screening in the australian colorectal cancer population |
| url | http://hdl.handle.net/20.500.11937/71547 |