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A cost-effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers†‡

  1. Hans F. A. Vasen1,2,*,
  2. Marjolein van Ballegooijen3,
  3. Eric Buskens4,
  4. Jan K. Kleibeuker5,
  5. Babs G. Taal6,
  6. Gerrit Griffioen2,
  7. Fokko M. Nagengast7,
  8. Fred H. Menko8,
  9. P. Meera Khan9

Article first published online: 31 OCT 2000

DOI: 10.1002/(SICI)1097-0142(19980501)82:9<1632::AID-CNCR6>3.0.CO;2-C

Issue

Cancer

Cancer

Volume 82, Issue 9, pages 1632–1637, 1 May 1998

Additional Information

How to Cite

Vasen, H. F., Ballegooijen, M. v., Buskens, E., Kleibeuker, J. K., Taal, B. G., Griffioen, G., Nagengast, F. M., Menko, F. H. and Khan, P. M. (1998), A cost-effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers. Cancer, 82: 1632–1637. doi: 10.1002/(SICI)1097-0142(19980501)82:9<1632::AID-CNCR6>3.0.CO;2-C

Author Information

  1. 1

    The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands

  2. 2

    Department of Gastroenterology, Leiden University Hospital, Leiden, the Netherlands

  3. 3

    Department of Public Health, Erasmus University, Rotterdam, the Netherlands

  4. 4

    Department of Epidemiology, University Hospital, Utrecht, the Netherlands

  5. 5

    Department of Gastroenterology, Groningen University Hospital, Groningen, the Netherlands

  6. 6

    Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, the Netherlands

  7. 7

    Department of Gastroenterology, Nijmegen University Hospital, Nijmegen, the Netherlands

  8. 8

    Department of Clinical Genetics, Free University Hospital, Amsterdam, the Netherlands

  9. 9

    MGC-Department of Human Genetics, Leiden University, Leiden, the Netherlands

*The Netherlands Foundation for the Detection of Hereditary Tumours, c/o University Hospital, Rijnsburgerweg 10, Building 50, 2333 AA Leiden, the Netherlands

  1. †

    The results of this study were presented at the meeting of the International Collaborative Group on Hereditary Nonpolyposis Colorectal Cancer (ICG-HNPCC), Buffalo, New York, August 11, 1996.

  2. ‡

    P. Meera Khan, Deceased.

Publication History

  1. Issue published online: 31 OCT 2000
  2. Article first published online: 31 OCT 2000
  3. Manuscript Revised: 26 NOV 1997
  4. Manuscript Accepted: 26 NOV 1997
  5. Manuscript Received: 21 JUL 1997

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Keywords:

  • hereditary nonpolyposis colorectal carcinoma;
  • gene carriers;
  • cost-effectiveness;
  • surveillance

Colorectal surveillance of hereditary nonpolyposis colorectal carcinoma gene carriers is effective and considerably less costly than no colorectal surveillance; therefore, it deserves to be supported by governmental agencies and health insurance organizations.

Abstract

BACKGROUND

It has been estimated that the prevalence of carriers of a mutated mismatch repair (MMR) gene among the general population in Western countries is between 5 and 50 per 10,000. These carriers have a risk of >85% of developing colorectal carcinoma (CRC) and therefore need careful follow-up. The objective of this study was to analyze the cost-effectiveness of CRC surveillance for carriers of a mutated MMR gene.

METHODS

The authors constructed a model to estimate the potential health effects (life expectancy) and healthcare costs of two strategies: 1) surveillance, with colonoscopy every 2-3 years, and 2) no CRC surveillance. Estimates of the lifetime risk of developing CRC and the stage distribution of CRC for symptomatic patients were derived from the Dutch hereditary nonpolyposis colorectal carcinoma (HNPCC) registry. The CRC stage specific relative survival rates and the effectiveness of surveillance in preventing or detecting cancer early were based on Finnish studies. The costs of surveillance and treatment were derived from recent American studies.

RESULTS

The results showed that 1) surveillance of gene carriers led to an increase in life expectancy of 7 years, and 2) the costs of surveillance under a wide range of assumptions are less than the costs of no CRC surveillance.

CONCLUSIONS

CRC surveillance of HNPCC gene carriers appears to be effective and considerably less costly than no CRC surveillance and therefore deserves to be supported by governmental agencies and health insurance organizations. Cancer 1998;82:1632-7. © 1998 American Cancer Society.

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