N06: The effectiveness and the cost-effectiveness of systematic testing for Lynch syndrome in incident colorectal cancer cases in Australia

Y. J. Kang1, J. Killen1, M. Caruana1, K. Simms1, N. Taylor1, I. Frayling2, A. Boussioutas3, 4, 5, G. Mitchell4, F. Macrae5, K. Canfell1

1 – Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia. 2 – Genetic Pathology, Cardiff, Wales, UK. 3 – The University of Melbourne. 4 – Peter MacCallum Cancer Centre. 5 – The Royal Melbourne Hospital.

 

Aim: The study aims to evaluate the effectiveness and cost-effectiveness of Lynch syndrome (LS) screening in incident colorectal cancer (CRC) cases diagnosed in 2017 in Australia via universal germline gene panel testing compared to no screening.

Method: A micro-simulation model was used to estimate health and resource outcomes under two different assumptions: i) colonoscopic surveillance reduces the CRC incidence and down stages (scenario 1); or ii) colonoscopic surveillance down stages only (scenario 2). A range of sensitivity analysis was also performed.

Results: LS screening for CRC cases of all ages with annual colonoscopic surveillance in confirmed LS carriers till age 70 years will cost from $66,557/life-year saved (LYS, scenario 1) to 111,143/LYS (scenario 2). An additional 35,948 to 36,476 colonoscopies will be generated in a given year but 136 to 208 CRC deaths will be averted per 1,000 LS carriers. The cost-effectiveness improves if: i) the gene panel testing cost is reduced from $1,200 capturing 11 gene variants related to hereditary CRC to $450 capturing MMR genes only ($38,665/LYS); or ii) a maximum age for screening is applied.

Conclusion: Our preliminary results indicate that LS screening via universal gene panel testing can be cost-effective if the testing cost is reduced.

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