Table 2 Cost-effective age-targeted CRC-based LS screening programs

From: Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

First author, year, country

N

Target population

Age cutoff

Clinical criteria

Tumor testing

Gene sequencing

Relatives cascade testing

Preventive strategy

Tier

ICERs

          

Comparisons

LYG

QALY

Age-targeted CRC-based LS screening programs accepted as cost-effective

?Sie 2014, Netherlands

12.2

New CRC patients

<70

—

MSI+IHC+MLH1 Hyperm.

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/MSI+IHC+MLH1 Hyperm.

2,703

—

?Leenen 2016, Netherlands

17.2

New CRC patients

<60

—

MSI+IHC+MLH1 Hyperm.

4 MMR genes+EPCAM

Y

Colonoscopy every 2 years + transvaginal US and endometrial biopsy every year or TAHBSO at age 40

—

Vs <50/MSI+IHC+MLH1 Hyperm.

4,226

—

?Snowsill 2015, UK

13.5

New CRC patients

<50

—

MSI+BRAF

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

5,491

?Snowsill 2015, UK

13.4

New CRC patients

<50

—

MSI

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

5,610

?Snowsill 2015, UK

13.6

New CRC patients

<50

—

MSI+BRAF+IHC

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

5,774

?Snowsill 2015, UK

13.3

New CRC patients

<50

—

IHC+BRAF

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

5,831

?Snowsill 2015, UK

13.1

New CRC patients

<50

Amst II

—

—

Y

Colonoscopy every 2 years

—

Vs NS

—

6,021

?Snowsill 2015, UK

13.2

New CRC patients

<50

—

IHC

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

6,444

?Leenen 2016, Netherlands

17.3

New CRC patients

<70

—

MSI+IHC+MLH1 Hyperm.

4 MMR genes+EPCAM

Y

Colonoscopy every 2 years + transvaginal US and endometrial biopsy every year or TAHBSO at age 40

2

Vs <60/MSI+IHC+MLH1 Hyperm.

7,051

—

?Leenen 2016, Netherlands

17.3

New CRC patients

<70

—

MSI +IHC+MLH1 Hyperm.

4 MMR genes+EPCAM

Y

Colonoscopy every 2 years + transvaginal US and endometrial biopsy every year or TAHBSO at age 40

2

Vs <70/RBG/MSI+IHC+MLH1 Hyperm.

7,341

—

?Snowsill 2015, UK

13.7

New CRC patients

<50

—

IHC (+MSI+BRAF)

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

7,601

?Mvundura 2010, USA

6.5

New CRC patients

<50

—

IHC+BRAF

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

7,832

—

?Mvundura 2010, USA

6.6

New CRC patients

<50

—

IHC

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

7,944

—

?Snowsill 2015, UK

13.8

New CRC patients

<50

—

—

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

—

9,571

?Mvundura 2010, USA

6.7

New CRC patients

<50

—

MSI

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

11,680

—

?CADTH 2016, Canada

19.8B°

New CRC patients (age >50)

<70

—

IHC+MLH1 Hyperm.

4 MMR genes

Y

Colonoscopy every 2 years + TAHBSO at age 45

—

Vs RBG/IHC + MLH1 Hyperm.°

19,455°

20,757°

?Mvundura 2010, USA

6.8

New CRC patients

<50

—

—

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs NS

44,902

—

?Mvundura 2010, USA

6.6

New CRC patients

<50

—

IHC

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/IHC+BRAF

60,569

—

Age-targeted CRC-based LS screening programs not accepted as cost-effective

?Snowsill 2015, UK

13.7

New CRC patients

<50

—

IHC (+MSI+BRAF)

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/MSI+BRAF

—

25,106

?Snowsill 2015, UK

13.8

New CRC patients

<50

—

—

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/IHC+MSI+BRAF

—

82,962

?Mvundura 2010, USA

6.7

New CRC patients

<50

—

MSI

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/IHC

168,905

—

?Mvundura 2010, USA

6.8

New CRC patients

<50

—

—

4 MMR genes

Y

Colonoscopy every 2 years

2

Vs <50/MSI

252,643

—

  1. 4 MMR genes, all 4 mismatch repair genes (MLH1, MSH2, MSH6, and PMS2); Amst II, Amsterdam II criteria; BRAF, BRAF testing; CADTH, Canadian Agency for Drugs & Technologies in Health; CRC, colorectal cancer; EPCAM, EPCAM gene; ICERs, incremental cost-effectiveness ratios; IHC, immunohistochemistry testing; LS, Lynch syndrome; LYG, life-years gained; MLH1 Hyperm., MLH1 hypermethylation testing; MSI, microsatellite instability testing; New CRC patients, newly diagnosed colorectal cancer patients; NS, no screening; QALY, quality-adjusted life-years; RBG, Revised Bethesda Guidelines criteria; TAHBSO, total abdominal hysterectomy and bilateral salpingo-oophorectomy; Tier, the Centers for Disease Control and Prevention (CDC) classification of genomic applications; transvaginal US, transvaginal ultrasonography; Y, yes.
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