title: Fourfold increased detection of Lynch syndrome by raising age limit for tumour genetic testing from 50 to 70 years is cost-effective.
abstract: BACKGROUND
  Recognising colorectal cancer (CRC) patients with Lynch syndrome (LS) can increase life expectancy of these patients and their close relatives. To improve identification of this under-diagnosed disease, experts suggested raising the age limit for CRC tumour genetic testing from 50 to 70 years. The present study evaluates the efficacy and cost-effectiveness of this strategy.
  
  
  METHODS
  Probabilistic efficacy and cost-effectiveness analyses were carried out comparing tumour genetic testing of CRC diagnosed at age 70 or below (experimental strategy) versus CRC diagnosed at age 50 or below (current practice). The proportions of LS patients identified and cost-effectiveness including cascade screening of relatives, were calculated by decision analytic models based on real-life data.
  
  
  RESULTS
  Using the experimental strategy, four times more LS patients can be identified among CRC patients when compared with current practice. Both the costs to detect one LS patient (€9437/carrier versus €4837/carrier), and the number needed to test for detecting one LS patient (42 versus 19) doubled. When family cascade screening was included, the experimental strategy was found to be highly cost-effective according to Dutch standards, resulting in an overall ratio of €2703 per extra life-year gained in additionally tested patients.
  
  
  CONCLUSIONS
  Testing all CRC tumours diagnosed at or below age 70 for LS is cost-effective. Implementation is important as relatives from the large number of LS patients that are missed by current practice, can benefit from life-saving surveillance.
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: A S
authors.initials: AS
authors.lastname: Sie
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Mensenkamp
authors.affiliation: Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: E M M
authors.initials: EMM
authors.lastname: Adang
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: M J L
authors.initials: MJL
authors.lastname: Ligtenberg
authors.affiliation: Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: nicoline.hoogerbrugge@radboudumc.nl.
authors.forename: N
authors.initials: N
authors.lastname: Hoogerbrugge
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000191:economics* / Q000235:genetics / Q000473:pathology; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications / Q000191:economics* / Q000235:genetics / Q000473:pathology; D003362:Cost-Benefit Analysis; D053843:DNA Mismatch Repair / Q000235:genetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Lynch syndrome; colorectal cancer; genetic; hereditary; screening