title: An economic viewpoint on alternative strategies for identifying persons with hereditary nonpolyposis colorectal cancer.
abstract: OBJECTIVE
  There is uncertainty regarding the optimal strategy for identifying mutation carriers among those with hereditary nonpolyposis colorectal cancer (HNPCC).
  
  
  METHODS
  We used decision analysis to compare the cost-effectiveness of 4 strategies among those with newly diagnosed colon cancer: (1) clinical and family history followed by microsatellite instability testing and germline testing (Bethesda guidelines); (2) universal microsatellite instability testing; (3) germline testing of those who meet clinical and family history criteria; and (4) universal germline testing.
  
  
  RESULTS
  The added cost per year of life saved (YLS) for each strategy was as follows: (1) 11,865 US dollars/YLS, (2) 35,617 US dollars/YLS, (3) 49,702 US dollars/YLS, and (4) 267,548 US dollars/YLS.
  
  
  CONCLUSIONS
  The Bethesda guidelines are the most cost-effectiveness approach to screen persons for HNPCC.
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis*; D004252:DNA Mutational Analysis / Q000191:economics; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D018895:Microsatellite Repeats