Display options
Cite
Alblas M, Peterse EFP, Du M, et al. Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study. Cancer Med. 2021;10(19):6835-6844doi: 10.1002/cam4.4080.
Alblas, M., Peterse, E. F. P., Du, M., Zauber, A. G., Steyerberg, E. W., van Leeuwen, N., & Lansdorp-Vogelaar, I. (2021). Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study. Cancer medicine, 10(19), 6835-6844. https://doi.org/10.1002/cam4.4080
Alblas, Maaike, et al. "Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study." Cancer medicine vol. 10,19 (2021): 6835-6844. doi: https://doi.org/10.1002/cam4.4080
Alblas M, Peterse EFP, Du M, Zauber AG, Steyerberg EW, van Leeuwen N, Lansdorp-Vogelaar I. Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study. Cancer Med. 2021 Oct;10(19):6835-6844. doi: 10.1002/cam4.4080. Epub 2021 Sep 12. PMID: 34510779; PMCID: PMC8495276.
Copy Download .nbib Format: NLM
Share it on

Cancer Med. 2021 Oct;10(19):6835-6844. doi: 10.1002/cam4.4080. Epub 2021 Sep 12.

Cost-effectiveness of prophylactic hysterectomy in first-degree female relatives with Lynch syndrome of patients diagnosed with colorectal cancer in the United States: a microsimulation study.

Cancer medicine

Maaike Alblas, Elisabeth F P Peterse, Mengmeng Du, Ann G Zauber, Ewout W Steyerberg, Nikki van Leeuwen, Iris Lansdorp-Vogelaar

Affiliations

  1. Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
  2. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
  3. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  4. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 34510779 PMCID: PMC8495276 DOI: 10.1002/cam4.4080

Abstract

BACKGROUND: To evaluate the cost-effectiveness of prophylactic hysterectomy (PH) in women with Lynch syndrome (LS).

METHODS: We developed a microsimulation model incorporating the natural history for the development of hyperplasia with and without atypia into endometrial cancer (EC) based on the MISCAN-framework. We simulated women identified as first-degree relatives (FDR) with LS of colorectal cancer patients after universal testing for LS. We estimated costs and benefits of offering this cohort PH, accounting for reduced quality of life after PH and for having EC. Three minimum ages (30/35/40) and three maximum ages (70/75/80) were compared to no PH.

RESULTS: In the absence of PH, the estimated number of EC cases was 300 per 1,000 women with LS. Total associated costs for treatment of EC were $5.9 million. Offering PH to FDRs aged 40-80 years was considered optimal. This strategy reduced the number of endometrial cancer cases to 5.4 (-98%), resulting in 516 quality-adjusted life years (QALY) gained and increasing the costs (treatment of endometrial cancer and PH) to $15.0 million (+154%) per 1,000 women. PH from earlier ages was more costly and resulted in fewer QALYs, although this finding was sensitive to disutility for PH.

CONCLUSIONS: Offering PH to 40- to 80-year-old women with LS is expected to add 0.5 QALY per person at acceptable costs. Women may decide to have PH at a younger age, depending on their individual disutility for PH and premature menopause.

© 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Keywords: advisory committees; cost-effectiveness; hysterectomy; lynch syndrome; microsimulation; microsimulation model; theoretical

References

  1. Med Decis Making. 2011 Jul-Aug;31(4):540-9 - PubMed
  2. Fam Cancer. 2005;4(4):301-5 - PubMed
  3. BMJ. 2011 Apr 26;342:d2202 - PubMed
  4. Int J Cancer. 1999 Apr 12;81(2):214-8 - PubMed
  5. JAMA. 2004 Mar 24;291(12):1456-63 - PubMed
  6. Climacteric. 2011 Oct;14(5):565-72 - PubMed
  7. Cancer Epidemiol Biomarkers Prev. 2009 Aug;18(8):2318-24 - PubMed
  8. Gastroenterology. 2015 Sep;149(3):777-82; quiz e16-7 - PubMed
  9. Ann Intern Med. 2014 Jun 3;160(11):750-9 - PubMed
  10. J Gastroenterol Hepatol. 2018 Oct;33(10):1737-1744 - PubMed
  11. N Engl J Med. 2014 Aug 28;371(9):796-7 - PubMed
  12. J Natl Cancer Inst. 2015 Nov 18;108(2): - PubMed
  13. J Clin Oncol. 2015 Jan 10;33(2):209-17 - PubMed
  14. Gynecol Oncol. 2011 Jun 1;121(3):462-5 - PubMed
  15. Genet Med. 2016 Oct;18(10):966-73 - PubMed
  16. Clin Gastroenterol Hepatol. 2013 Sep;11(9):1093-100 - PubMed
  17. J Med Genet. 2010 Feb;47(2):99-102 - PubMed
  18. JAMA. 2006 Sep 27;296(12):1507-17 - PubMed
  19. JAMA. 2016 Sep 13;316(10):1093-103 - PubMed
  20. Hum Mol Genet. 1997 Jan;6(1):105-10 - PubMed
  21. Anticancer Res. 1994 Jul-Aug;14(4B):1675-8 - PubMed
  22. Med Decis Making. 1993 Apr-Jun;13(2):89-102 - PubMed
  23. N Engl J Med. 2006 Jan 19;354(3):261-9 - PubMed
  24. J Clin Oncol. 2010 Feb 10;28(5):788-92 - PubMed
  25. Gastroenterology. 2014 Aug;147(2):502-26 - PubMed
  26. Cancer Prev Res (Phila). 2011 Jan;4(1):1-5 - PubMed
  27. Natl Vital Stat Rep. 2013 Dec 30;62(9):1-68 - PubMed
  28. Health Technol Assess. 2011 Apr;15(19):iii-xvi, 1-252 - PubMed
  29. Gut. 2013 Jun;62(6):812-23 - PubMed
  30. Cancer Med. 2021 Oct;10(19):6835-6844 - PubMed
  31. Am J Obstet Gynecol. 2009 Jun;200(6):640.e1-8 - PubMed
  32. J Natl Cancer Inst. 2009 Oct 21;101(20):1412-22 - PubMed
  33. NCHS Data Brief. 2009 Aug;(21):1-8 - PubMed
  34. Popul Health Manag. 2015 Oct;18(5):373-82 - PubMed
  35. Med J Aust. 2014 Oct 20;201(8):456-61 - PubMed
  36. Cancer Epidemiol Biomarkers Prev. 2017 Mar;26(3):404-412 - PubMed
  37. Genet Med. 2010 Feb;12(2):93-104 - PubMed
  38. Cancer. 2006 Jan 1;106(1):87-94 - PubMed
  39. JAMA. 2011 Jun 8;305(22):2304-10 - PubMed
  40. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2760-2767.e12 - PubMed
  41. Cancer. 2008 Jul 15;113(2):326-35 - PubMed
  42. BMC Health Serv Res. 2018 Oct 30;18(1):824 - PubMed
  43. Gastroenterology. 2010 Jun;138(7):2197.e1-7 - PubMed
  44. Fam Cancer. 2011 Sep;10(3):535-43 - PubMed

Publication Types

Grant support