An economic viewpoint on alternative strategies for identifying persons with hereditary nonpolyposis colorectal cancer.
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.
D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis*; D004252:DNA Mutational Analysis / Q000191:economics; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D018895:Microsatellite Repeats