Cost-effectiveness of routine screening for Lynch syndrome in endometrial cancer patients up to 70 years of age

Abstract

Purpose To assess cost-effectiveness of routine screening for Lynch Syndrome (LS) in endometrial cancer (EC) patients ≤ 70 years of age. Methods Consecutive EC patients ≤ 70 years of age were screened for LS by analysis of microsatellite instability, immunohistochemistry and MLH1 hypermethylation. Costs and health benefit in life years gained (LYG) included surveillance for LS carriers among EC patients and relatives. We calculated incremental cost-effectiveness ratios (ICERs) comparing LS screening among EC patients ≤ 70 years with ≤ 50 years and the revised Bethesda guidelines. Results Screening for LS in 179 EC patients identified 7 LS carriers; 1 was ≤ 50 and 6 were 51-70 years. Per age category 18 and 9 relatives were identified as LS carrier. Screening resulted in 74,7 LYG (45,4 and 29,3 LYG per age category). The ICER for LS screening in EC patients ≤ 70 compared with ≤ 50 years was €5,252/LYG. The revised Bethesda guidelines missed 4/7 (57%) LS carriers among EC patients. The ICER for LS screening in EC patients ≤ 70 years of age compared with the revised Bethesda guidelines was €6,668/LYG. Both ICERs remained