Which Lynch syndrome screening programs could be implemented in the "real world"? A systematic review of economic evaluations. - PubMed - NCBI
Genet Med. 2018 Jan 4. doi: 10.1038/gim.2017.244. [Epub ahead of print]
Which Lynch syndrome screening programs could be implemented in the "real world"? A systematic review of economic evaluations.
Di Marco M1,
D'Andrea E1,2,
Panic N3,4,
Baccolini V1,
Migliara G1,
Marzuillo C1,
De Vito C1,
Pastorino R4,
Boccia S5,
Villari P1.
Abstract
PurposeLynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."MethodsWe performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.ResultsOverall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with age-targeted programs with lower age thresholds.ConclusionUniversal or <70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world."GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.244.
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