Cost-effectiveness analysis of reflex testing for Lynch syndrome in women with endometrial cancer in the UK setting

Tristan M Snowsill, Neil A J Ryan, Emma J Crosbie, Ian M Frayling, D Gareth Evans, Chris J Hyde

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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 £20 000/QALY was used.

RESULTS: Reflex testing for Lynch syndrome using MMR immunohistochemistry and MLH1 methylation testing was cost-effective versus no testing, costing £14 200 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.

Original languageEnglish
Pages (from-to)e0221419
JournalPLoS ONE
Volume14
Issue number8
Early online date30 Aug 2019
DOIs
Publication statusE-pub ahead of print - 30 Aug 2019

Keywords

  • Adult
  • Age Factors
  • Aged
  • Colorectal Neoplasms, Hereditary Nonpolyposis/complications
  • Cost-Benefit Analysis
  • DNA Mismatch Repair/genetics
  • Endometrial Neoplasms/complications
  • Female
  • Genetic Testing/economics
  • Humans
  • Immunohistochemistry
  • Microsatellite Instability
  • Middle Aged
  • Quality-Adjusted Life Years
  • Reflex/genetics
  • United Kingdom/epidemiology

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