A cost‐effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers

Vasen, Hans F. A.; Ballegooijen, Marjolein van; Buskens, Erik; Kleibeuker, Jan; Taal, Babs G.; Griffioen, G.; Nagengast, Fokko M.; Menko, Fred H.; Khan, P. Meera

doi:10.1002/(sici)1097-0142(19980501)82:9<1632::aid-cncr6>3.3.co;2-x

Cited by 38 publications

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“…Vasen et al [39] have estimated that colonoscopic surveillance of gene carriers leads to an increase in life expectancy of 7 years and that the costs of surveillance are less than the costs of the treatment of tumours diagnosed on the burns of symptoms. Identification of true mutation carriers by mutation analysis and predictive testing of high-risk members has been shown to be cost-effective compared to the life-long screening of all family members at risk, especially in large families [40].…”

Section: The Cost-effectiveness Of Surveillancementioning

confidence: 99%

Surveillance in Lynch Syndrome

Mecklin∥

Järvinen

2005

Familial Cancer

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The major aim of surveillance in Lynch syndrome is to diagnose malignant or premalignant lesions at the asymptomatic stage by regular checkups, particularly in the large bowel. Therefore, screening for colorectal adenomas and carcinomas by regular colonoscopies is the main topic of the present review. However, it should be remembered, that primary prevention - whether through the use of chemoprevention or the promotion of a healthy life-style may form a significant part of such surveillance in the future. Observational studies indicate that the adenoma carcinoma sequence is the main pathway in the development of colorectal cancer in Lynch syndrome. A colonoscopy every 1-3 years starting at age 20 to 25 years and the removal of observed adenomas is recommended for individuals known to have Lynch syndrome associated mutations. The incidence of colorectal cancer in family branches screened this way is lower than that in past unscreened generations. The screening of other malignancies associated with Lynch syndrome is more complex. Screening for endometrial cancer has recommended previously, but no benefits have been shown in recent studies. The value of screening for other extracolonic cancers remains also uncertain.

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Section: The Cost-effectiveness Of Surveillancementioning

confidence: 99%

Surveillance in Lynch Syndrome

Mecklin∥

Järvinen

2005

Familial Cancer

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“…The most recent study by Dinh et al [16] showed that primary screening by genetic testing for risk assessment in unaffected individuals could be cost-effective as compared to current practice based on clinical risk criteria after a malignancy was detected. Some studies [21,22] dealt with mutation carriers only in evaluating the cost-effectiveness of different surveillance programs, while some [23] focused on the cost-effectiveness of including moderate risk families for genetic testing and surveillance programs. There is only one study by Breheny [24] that specifically addressed the impact of genetic testing among asymptomatic first-degree relatives of known mutation carriers.…”

Section: Introductionmentioning

confidence: 99%

Predictive genetic testing of first degree relatives of mutation carriers is a cost-effective strategy in preventing hereditary non-polyposis colorectal cancer in Singapore

et al. 2012

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Colorectal cancer (CRC) is the most common cancer in Singapore. We sought to evaluate the long-term cost-effectiveness of targeted genetic testing and surveillance programs in individuals at high risk of hereditary non-polyposis colorectal cancer (HNPCC), as compared to an unselective clinical surveillance program alone in Singapore. A Markov model analysis from the healthcare service provider's perspective was developed to follow over a lifetime a cohort of cancer-free 21-year-old individuals, who were first-degree relatives of HNPCC patients with a known mutation. Genetic testing strategy provided a lifetime saving of Singapore dollars (SGD) 13,588 per person and gained additional life years of 0.01, as compared to clinical surveillance alone, by sparing non-mutation carriers from unnecessary and invasive intensive clinical surveillance (assuming 100% compliance with recommended surveillance programs in both strategies). Sensitivity analyses showed that as long as the compliance rate in mutation carriers was not lower than that for individuals without genetic testing, pursuing a genetic testing strategy would either be a more favorable option with discounted incremental cost-effectiveness ratios ranging from SGD 6,961 to 17,289 per life year gained or a dominant status achieved (more life year gained and less costly). Genetic testing for individuals at high risk of HNPCC allows targeted clinical surveillance to be directed at mutation carriers, ensuring efficient use of healthcare resources and reduces CRC-related mortality. It can be regarded as a cost-effective strategy in Singapore, if an improved compliance with recommended surveillance protocol is achieved in proven mutation carriers.

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“…Because of a high incidence and an early age at onset of cancer, targeted surveillance programmes are recommended. Early detection and removal of precancerous adenomas and early-stage cancers significantly reduce the colorectal cancer burden and has demonstrated favourable cost efficacy [23,24]. The need for initiation of surveillance at early age, i.e.…”

Section: Discussionmentioning

confidence: 99%

An effect from anticipation also in hereditary nonpolyposis colorectal cancer families without identified mutations

Timshel

Therkildsen

Bendahl

et al. 2009

Cancer Epidemiology

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A cost‐effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers

Abstract: CRC surveillance of HNPCC gene carriers appears to be effective and considerably less costly than no CRC surveillance and therefore deserves to be supported by governmental agencies and health insurance organizations.

Cited by 38 publications

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Surveillance in Lynch Syndrome

Surveillance in Lynch Syndrome

Predictive genetic testing of first degree relatives of mutation carriers is a cost-effective strategy in preventing hereditary non-polyposis colorectal cancer in Singapore

An effect from anticipation also in hereditary nonpolyposis colorectal cancer families without identified mutations

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