title: Economic evaluation of genetic screening for Lynch syndrome in Germany.
abstract: OBJECTIVE
  Lynch syndrome (LS) screening among patients with newly diagnosed colorectal cancer can decrease mortality in their affected first-degree relatives. In Germany, it is not yet clinical practice and the cost-effectiveness of different testing strategies is unknown.
  
  
  METHODS
  We developed a decision-analytic model to analyze the cost-effectiveness of LS screening from the perspective of the German Statutory Health Insurance system. A total of 22 testing strategies considering family-history assessment, analysis of tumor samples (i.e., immunohistochemistry (IHC), microsatellite instability, and BRAF mutation testing) and genetic sequencing were analyzed. Life-years gained in relatives by closed-meshed colonoscopy and aspirin prophylaxis were estimated by Markov models. Uncertainty was assessed deterministically and probabilistically.
  
  
  RESULTS
  On average, detected mutation carriers gained 0.52 life-years (undiscounted: 1.34) by increased prevention. Most strategies were dominated, with three exceptions: family assessment by the Bethesda criteria followed by IHC and BRAF testing and genetic sequencing; IHC and BRAF testing and genetic sequencing; and direct sequencing of all index patients. Their incremental cost-effectiveness was [euro ]77,268, [euro ]253,258, and [euro ]4,188,036 per life-year gained, respectively.
  
  
  CONCLUSIONS
  The results were less favorable than those of previous models. Chemoprevention appears to provide comparably low additional benefit and improves cost-effectiveness only slightly.
authors.affiliation: Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Severin
authors.affiliation: Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Stollenwerk
authors.affiliation: Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Holinski-Feder
authors.affiliation: Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Elisabeth
authors.identifier: http://orcid.org/0000-0001-5543-3426
authors.initials: E
authors.lastname: Meyer
authors.affiliation: Department of Medical Oncology and Comprehensive Cancer Center, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Heinemann
authors.affiliation: Department of Medical Oncology and Comprehensive Cancer Center, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Giessen-Jung
authors.affiliation: Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Rogowski
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003695:Delivery of Health Care; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005820:Genetic Testing / Q000191:economics*; D005858:Germany; D006579:Heterozygote; D006801:Humans; D008390:Markov Chains; D009154:Mutation; D010342:Patient Acceptance of Health Care; D057285:Precision Medicine / Q000191:economics / Q000379:methods