Cost-effectiveness analysis of annual screening strategies for endometrial cancer

Havrilesky, Laura J.; Maxwell, G. Larry; Myers, Evan R.

doi:10.1016/j.ajog.2009.02.022

Cited by 29 publications

(40 citation statements)

References 15 publications

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“…152 However, this figure is not given in the source publication and Ladabaum and colleagues 48 do not explain how they derived the figure from the publication. Further, although not stated, we assume that this refers to the total mean lifetime cost of care for EC per person.…”

Section: Ladabaum and Colleagues (2011)mentioning

confidence: 99%

“…There is a range of possible chemotherapies for EC, including single-agent carboplatin or paclitaxel, combination carboplatin plus paclitaxel and combination paclitaxel, doxorubicin and cisplatin (TAP). 160 In a US study of the cost-effectiveness of screening for EC, 152 the following costs were assumed:…”

Section: Ladabaum and Colleagues (2011)mentioning

confidence: 99%

“…We base our estimate on the value of $7895 from the study by Havrilesky and colleagues (2009), 152 which is similar to the estimate of $8418 used in the model of Yang and colleagues (2011). 76 First, the $7895 is adjusted from US dollars to pounds sterling by purchasing power parities and from year 2009 to 2011, 254 to yield £5520.…”

Section: Cost Of Radiotherapy For Endometrial Cancermentioning

confidence: 99%

“…In our model, we assume the same treatment regime and distribution of stages of cancer as Havrilesky and colleagues 152 because it is consistent with the treatment of EC in the UK, described above. More precisely, the following split across stages at diagnosis is assumed: 73% stage I, 18% stages II and III, 9% stage IV, where the 4% unknowns are spread across the stages.…”

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confidence: 99%

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A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

108

234

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BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Ladabaum and Colleagues (2011)mentioning

confidence: 99%

Section: Ladabaum and Colleagues (2011)mentioning

confidence: 99%

Section: Cost Of Radiotherapy For Endometrial Cancermentioning

confidence: 99%

mentioning

confidence: 99%

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A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

108

234

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“…This was based on an average cost of £3345 for HRG codes MA07E-MA07G (Major Open Upper Genital Tract Procedures) and MA08A-MA08B (Major, Laparoscopic or Endoscopic, Upper Genital Tract Procedures). Radiotherapy Havrilesky et al 169 estimated a cost of US$7895 for a course of radiotherapy for endometrial cancer. It was estimated that this corresponded to a cost of £5870 in 2016/17 prices (based on the same methodology as previously employed 4 ).…”

mentioning

confidence: 99%

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

Snowsill

Coelho

Huxley

et al. 2017

Health Technol Assess

112

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BackgroundInherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests – microsatellite instability (MSI) and MMR immunohistochemistry (IHC) – are used in CRC patients to identify individuals at high risk of LS for genetic testing.MLH1(MutL homologue 1) promoter methylation andBRAFV600E testing can be conducted on tumour material to rule out certain sporadic cancers.ObjectivesTo investigate whether testing for LS in CRC patients using MSI or IHC (with or withoutMLH1promoter methylation testing andBRAFV600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources.Review methodsSystematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors.ResultsTen studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC,BRAFV600E andMLH1promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective.LimitationsMost of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted.ConclusionsSystematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients.Study registrationThis study is registered as PROSPERO CRD42016033879.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost‐effectiveness of prophylactic hysterectomy in first‐degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study

Alblas

Peterse

et al. 2021

Cancer Medicine

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Cost-effectiveness analysis of annual screening strategies for endometrial cancer

Cited by 29 publications

References 15 publications

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

Cost‐effectiveness of prophylactic hysterectomy in first‐degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study

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