title: Cost-utility analysis of genetic screening in families of patients with germline MUTYH mutations.
abstract: BACKGROUND
  MUTYH associated polyposis (MAP) is an autosomal recessive inherited disorder. Carriers of bi-allelic MUTYH germline mutations have a risk of approximately 60% to develop colorectal carcinoma (CRC). In the general population about 1.5% is a heterozygous MUTYH mutation carrier. Children of MAP patients have an increased risk of inheriting two MUTYH mutations compared to the general population, implicating an increased risk for developing CRC.
  
  
  METHODS
  Using data from the literature and Dutch MAP patients (n = 40), we constructed a Markov model to perform a societal cost-utility analysis of genetic screening in MAP families. Genetic screening was done by testing the spouse first and, in case of a heterozygous spouse, also testing of the children.
  
  
  RESULTS
  The cost of genetic screening of families of MAP patients, when compared to no genetic screening, was estimated at 25,000 euros per quality-adjusted life year (QALY). The presence of Fecal Occult Blood testing (FOBT) population screening only slightly increased this cost-utility ratio to 25,500 euros per QALY. For a MUTYH heterozygote index-patient, the ratio was 51,500 euros per QALY. The results of our analysis were sensitive to several of the parameters in the model, including the cost assumed for molecular genetic testing.
  
  
  CONCLUSIONS
  The costs per QALY of genetic screening in families of MAP patients are acceptable according to international standards. Therefore, genetic testing of spouses and/or children should be discussed with and offered to counselees.
authors.affiliation: Center for Human and Clinical Genetics, Leiden University Medical Center, The Netherlands. m.nielsen@lumc.nl
authors.forename: Maartje
authors.initials: M
authors.lastname: Nielsen
authors.forename: Frederik J
authors.initials: FJ
authors.lastname: Hes
authors.forename: Hans F A
authors.initials: HF
authors.lastname: Vasen
authors.forename: Wilbert B
authors.initials: WB
authors.lastname: van den Hout
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000191:economics / Q000453:epidemiology / Q000235:genetics*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000191:economics / Q000453:epidemiology / Q000235:genetics*; D003362:Cost-Benefit Analysis; D045647:DNA Glycosylases / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics*; D018095:Germ-Line Mutation; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010375:Pedigree; D019057:Quality-Adjusted Life Years
chemical_list: D045647:DNA Glycosylases; C061738:mutY adenine glycosylase