Economic considerations for healthcare guidelines for gynaecological cancer in Lynch syndrome

Tristan Snowsill

Health Economics Group, University of Exeter, Exeter, United Kingdom

Abstract

Objectives: Healthcare systems are intended to make use of limited resources to prevent and alleviate the effects of disease within a population. As resources are limited there is pressure to make healthcare spending as efficient as possible. Cost-effectiveness analyses are employed to assess whether proposed changes to healthcare are a good use of limited resources, but this is dependent on the short and long-term impacts on health and on other resource use. The objective is to summarise the economic considerations that apply when developing healthcare guidelines for gynaecological cancer in Lynch syndrome, to present case studies and highlight future areas for research.

Methods: Literature review and economic modelling.

Results: The economic values of interventions in Lynch syndrome are interrelated. For example, the economic value of efforts to identify Lynch syndrome depend on the economic value of interventions to manage future cancer risk. The economic value of interventions to manage cancer risk in turn depend on the casemix which is affected by the identification efforts. Based on recent evidence, testing for Lynch syndrome in younger endometrial cancer patients is cost-effective in the UK NHS, but surveillance is unlikely to be cost-effective in patients for whom risk-reducing surgery is acceptable. Better understanding of the natural history of Lynch syndrome and the effectiveness of interventions are needed.

Conclusions: Healthcare guidelines should be made with consideration of cost-effectiveness. The development of a whole-disease economic model for Lynch syndrome would be valuable, potentially through open-source international collaboration.

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