Cost-effectiveness of population-wide genomic screening for Lynch syndrome in the United States
Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved..
PURPOSE: Genomic screening for Lynch syndrome (LS) could prevent colorectal cancer (CRC) by identifying high-risk patients and instituting intensive CRC screening. We estimated the cost-effectiveness of a population-wide LS genomic screening vs family history-based screening alone in an unselected US population.
METHODS: We developed a decision-analytic Markov model including health states for precancer, stage-specific CRC, and death and assumed an inexpensive test cost of $200. We conducted sensitivity and threshold analyses to evaluate model uncertainty.
RESULTS: Screening unselected 30-year-olds for LS variants resulted in 48 (95% credible range [CR] = 35-63) fewer overall CRC cases per 100,000 screened individuals, leading to 187 quality-adjusted life-years (QALYs; 95% CR = 123-260) gained at an incremental cost of $24.6 million (95% CR = $20.3 million-$29.1 million). The incremental cost-effectiveness ratio was $132,200, with an 8% and 71% probability of being cost-effective at $100,000 and $150,000 per QALY willingness-to-pay thresholds, respectively.
CONCLUSION: Population LS screening may be cost-effective in younger patient populations under a $150,000 willingness-to-pay per QALY threshold and with a relatively inexpensive test cost. Further reductions in testing costs and/or the inclusion of LS testing within a broader multiplex screening panel are needed for screening to become highly cost-effective.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Genetics in medicine : official journal of the American College of Medical Genetics - 24(2022), 5 vom: 25. Mai, Seite 1017-1026 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Guzauskas, Gregory F [VerfasserIn] |
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| Links: |
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| Themen: |
Colorectal cancer |
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| Anmerkungen: |
Date Completed 10.05.2022 Date Revised 21.11.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.gim.2022.01.017 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Guzauskas, Gregory F |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cost-effectiveness of population-wide genomic screening for Lynch syndrome in the United States |
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| 500 | |a Date Revised 21.11.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a PURPOSE: Genomic screening for Lynch syndrome (LS) could prevent colorectal cancer (CRC) by identifying high-risk patients and instituting intensive CRC screening. We estimated the cost-effectiveness of a population-wide LS genomic screening vs family history-based screening alone in an unselected US population | ||
| 520 | |a METHODS: We developed a decision-analytic Markov model including health states for precancer, stage-specific CRC, and death and assumed an inexpensive test cost of $200. We conducted sensitivity and threshold analyses to evaluate model uncertainty | ||
| 520 | |a RESULTS: Screening unselected 30-year-olds for LS variants resulted in 48 (95% credible range [CR] = 35-63) fewer overall CRC cases per 100,000 screened individuals, leading to 187 quality-adjusted life-years (QALYs; 95% CR = 123-260) gained at an incremental cost of $24.6 million (95% CR = $20.3 million-$29.1 million). The incremental cost-effectiveness ratio was $132,200, with an 8% and 71% probability of being cost-effective at $100,000 and $150,000 per QALY willingness-to-pay thresholds, respectively | ||
| 520 | |a CONCLUSION: Population LS screening may be cost-effective in younger patient populations under a $150,000 willingness-to-pay per QALY threshold and with a relatively inexpensive test cost. Further reductions in testing costs and/or the inclusion of LS testing within a broader multiplex screening panel are needed for screening to become highly cost-effective | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Colorectal cancer | |
| 650 | 4 | |a Cost-effectiveness analysis | |
| 650 | 4 | |a Lynch syndrome | |
| 650 | 4 | |a Population screening | |
| 700 | 1 | |a Jiang, Shangqing |e verfasserin |4 aut | |
| 700 | 1 | |a Garbett, Shawn |e verfasserin |4 aut | |
| 700 | 1 | |a Zhou, Zilu |e verfasserin |4 aut | |
| 700 | 1 | |a Spencer, Scott J |e verfasserin |4 aut | |
| 700 | 1 | |a Snyder, Susan R |e verfasserin |4 aut | |
| 700 | 1 | |a Graves, John A |e verfasserin |4 aut | |
| 700 | 1 | |a Williams, Marc S |e verfasserin |4 aut | |
| 700 | 1 | |a Hao, Jing |e verfasserin |4 aut | |
| 700 | 1 | |a Peterson, Josh F |e verfasserin |4 aut | |
| 700 | 1 | |a Veenstra, David L |e verfasserin |4 aut | |
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