Cost-Effectiveness of the Manchester Approach to Identifying Lynch Syndrome in Women with Endometrial Cancer
Lynch syndrome (LS) is a hereditary cancer syndrome responsible for 3% of all endometrial cancer and 5% in those aged under 70 years. It is unclear whether universal testing for LS in endometrial cancer patients would be cost-effective. The Manchester approach to identifying LS in endometrial cancer patients uses immunohistochemistry (IHC) to detect mismatch repair (MMR) deficiency, incorporates testing for MLH1 promoter hypermethylation, and incorporates genetic testing for pathogenic MMR variants. We aimed to assess the cost-effectiveness of the Manchester approach on the basis of primary research data from clinical practice in Manchester. The Proportion of Endometrial Tumours Associated with Lynch Syndrome (PETALS) study informed estimates of diagnostic performances for a number of different strategies. A recent microcosting study was adapted and was used to estimate diagnostic costs. A Markov model was used to predict long-term costs and health outcomes (measured in quality-adjusted life years, QALYs) for individuals and their relatives. Bootstrapping and probabilistic sensitivity analysis were used to estimate the uncertainty in cost-effectiveness. The Manchester approach dominated other reflex testing strategies when considering diagnostic costs and Lynch syndrome cases identified. When considering long-term costs and QALYs the Manchester approach was the optimal strategy, costing £5459 per QALY gained (compared to thresholds of £20,000 to £30,000 per QALY commonly used in the National Health Service (NHS)). Cost-effectiveness is not an argument for restricting testing to younger patients or those with a strong family history. Universal testing for Lynch syndrome in endometrial cancer patients is expected to be cost-effective in the U.K. (NHS), and the Manchester approach is expected to be the optimal testing strategy.
Citation
@article{t.m.2020,
author = {Snowsill, T. M. and Ryan, N. A. J. and Crosbie, E. J.},
title = {Cost-Effectiveness of the {Manchester} {Approach} to
{Identifying} {Lynch} {Syndrome} in {Women} with {Endometrial}
{Cancer}},
journal = {J Clin Med},
volume = {9},
number = {6},
pages = {1664},
date = {2020},
url = {https://tristansnowsill.co.uk/cost-effectiveness-of-the-manchester-approach.html},
doi = {10.3390/jcm9061664},
langid = {en},
abstract = {Lynch syndrome (LS) is a hereditary cancer syndrome
responsible for 3\% of all endometrial cancer and 5\% in those aged
under 70 years. It is unclear whether universal testing for LS in
endometrial cancer patients would be cost-effective. The Manchester
approach to identifying LS in endometrial cancer patients uses
immunohistochemistry (IHC) to detect mismatch repair (MMR)
deficiency, incorporates testing for MLH1 promoter hypermethylation,
and incorporates genetic testing for pathogenic MMR variants. We
aimed to assess the cost-effectiveness of the Manchester approach on
the basis of primary research data from clinical practice in
Manchester. The Proportion of Endometrial Tumours Associated with
Lynch Syndrome (PETALS) study informed estimates of diagnostic
performances for a number of different strategies. A recent
microcosting study was adapted and was used to estimate diagnostic
costs. A Markov model was used to predict long-term costs and health
outcomes (measured in quality-adjusted life years, QALYs) for
individuals and their relatives. Bootstrapping and probabilistic
sensitivity analysis were used to estimate the uncertainty in
cost-effectiveness. The Manchester approach dominated other reflex
testing strategies when considering diagnostic costs and Lynch
syndrome cases identified. When considering long-term costs and
QALYs the Manchester approach was the optimal strategy, costing
£5459 per QALY gained (compared to thresholds of £20,000 to £30,000
per QALY commonly used in the National Health Service (NHS)).
Cost-effectiveness is not an argument for restricting testing to
younger patients or those with a strong family history. Universal
testing for Lynch syndrome in endometrial cancer patients is
expected to be cost-effective in the U.K. (NHS), and the Manchester
approach is expected to be the optimal testing strategy.}
}