Cost-effectiveness analysis of reflex testing for Lynch syndrome in women with endometrial cancer in the UK setting
BACKGROUND: Lynch syndrome is a hereditary cancer syndrome caused by constitutional pathogenic variants in the DNA mismatch repair (MMR) system, leading to increased risk of colorectal, endometrial and other cancers. The study aimed to identify the incremental costs and consequences of strategies to identify Lynch syndrome in women with endometrial cancer. METHODS: A decision-analytic model was developed to evaluate the relative cost-effectiveness of reflex testing strategies for identifying Lynch syndrome in women with endometrial cancer taking the NHS perspective and a lifetime horizon. Model input parameters were sourced from various published sources. Consequences were measured using quality-adjusted life years (QALYs). A cost-effectiveness threshold of pound20 000/QALY was used. RESULTS: Reflex testing for Lynch syndrome using MMR immunohistochemistry and MLH1 methylation testing was cost-effective versus no testing, costing pound14 200 per QALY gained. There was uncertainty due to parameter imprecision, with an estimated 42% chance this strategy is not cost-effective compared with no testing. Age had a significant impact on cost-effectiveness, with testing not predicted to be cost-effective in patients aged 65 years and over. CONCLUSIONS: Testing for Lynch syndrome in younger women with endometrial cancer using MMR immunohistochemistry and MLH1 methylation testing may be cost-effective. Age cut-offs may be controversial and adversely affect implementation.
Citation
@article{t.m.2019,
author = {Snowsill, T. M. and Ryan, N. A. J. and Crosbie, E. J. and
Frayling, I. M. and Evans, D. G. and Hyde, C. J.},
title = {Cost-Effectiveness Analysis of Reflex Testing for {Lynch}
Syndrome in Women with Endometrial Cancer in the {UK} Setting},
journal = {PLoS One},
volume = {14},
number = {8},
pages = {e0221419},
date = {2019-08-01},
url = {https://tristansnowsill.co.uk/cost-effectiveness-analysis-of-reflex-testing-for-lynch.html},
doi = {10.1371/journal.pone.0221419},
langid = {en},
abstract = {BACKGROUND: Lynch syndrome is a hereditary cancer syndrome
caused by constitutional pathogenic variants in the DNA mismatch
repair (MMR) system, leading to increased risk of colorectal,
endometrial and other cancers. The study aimed to identify the
incremental costs and consequences of strategies to identify Lynch
syndrome in women with endometrial cancer. METHODS: A
decision-analytic model was developed to evaluate the relative
cost-effectiveness of reflex testing strategies for identifying
Lynch syndrome in women with endometrial cancer taking the NHS
perspective and a lifetime horizon. Model input parameters were
sourced from various published sources. Consequences were measured
using quality-adjusted life years (QALYs). A cost-effectiveness
threshold of pound20 000/QALY was used. RESULTS: Reflex testing for
Lynch syndrome using MMR immunohistochemistry and MLH1 methylation
testing was cost-effective versus no testing, costing pound14 200
per QALY gained. There was uncertainty due to parameter imprecision,
with an estimated 42\% chance this strategy is not cost-effective
compared with no testing. Age had a significant impact on
cost-effectiveness, with testing not predicted to be cost-effective
in patients aged 65 years and over. CONCLUSIONS: Testing for Lynch
syndrome in younger women with endometrial cancer using MMR
immunohistochemistry and MLH1 methylation testing may be
cost-effective. Age cut-offs may be controversial and adversely
affect implementation.}
}