title: Cost-effectiveness of routine screening for Lynch syndrome in endometrial cancer patients up to 70years of age.
abstract: OBJECTIVE
  To assess cost-effectiveness of routine screening for Lynch Syndrome (LS) in endometrial cancer (EC) patients ≤70years of age.
  
  
  METHODS
  Consecutive EC patients ≤70years of age were screened for LS by analysis of microsatellite instability, immunohistochemistry and MLH1 hypermethylation. Costs and health benefit in life years gained (LYG) included surveillance for LS carriers among EC patients and relatives. We calculated incremental cost-effectiveness ratios (ICERs) comparing LS screening among EC patients ≤70years with ≤50years and the revised Bethesda guidelines.
  
  
  RESULTS
  Screening for LS in 179 EC patients identified 7 LS carriers; 1 was ≤50 and 6 were 51-70years. Per age category 18 and 9 relatives were identified as LS carrier. Screening resulted in 74,7 LYG (45,4 and 29,3 LYG per age category). The ICER for LS screening in EC patients ≤70 compared with ≤50years was €5,252/LYG. The revised Bethesda guidelines missed 4/7 (57%) LS carriers among EC patients. The ICER for LS screening in EC patients ≤70years of age compared with the revised Bethesda guidelines was €6,668/LYG. Both ICERs remained <€16,000/LYG in sensitivity analyses.
  
  
  CONCLUSIONS
  Routine LS screening in EC patients ≤70years is a cost-effective strategy, allowing colorectal cancer prevention in EC patients and their relatives.
authors: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Anne
authors: A
authors: Goverde
authors: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Manon Cw
authors: MC
authors: Spaander
authors: Department of Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Helena C
authors: HC
authors: van Doorn
authors: Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Hendrikus J
authors: HJ
authors: Dubbink
authors: Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Ans Mw
authors: AM
authors: van den Ouweland
authors: Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
authors: Carli M
authors: CM
authors: Tops
authors: Department of Gynaecology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
authors: Sjarlot G
authors: SG
authors: Kooi
authors: Department of Gynaecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
authors: Judith
authors: J
authors: de Waard
authors: Pathology Laboratory Pathan, Rotterdam, The Netherlands.
authors: Robert F
authors: RF
authors: Hoedemaeker
authors: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Marco J
authors: MJ
authors: Bruno
authors: Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Robert Mw
authors: RM
authors: Hofstra
authors: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Esther W
authors: EW
authors: de Bekker-Grob
authors: Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Winand Nm
authors: WN
authors: Dinjens
authors: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
authors: Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. Electronic address: a.wagner@erasmusmc.nl.
authors: Anja
authors: A
authors: Wagner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D019175:DNA Methylation; D053843:DNA Mismatch Repair / Q000235:genetics*; D004252:DNA Mutational Analysis; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000235:genetics*; D005190:Family; D005260:Female; D005817:Genetic Counseling / Q000191:economics; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D007150:Immunohistochemistry; D055847:Lynch Syndrome II / Q000175:diagnosis* / Q000235:genetics; D008403:Mass Screening; D053842:Microsatellite Instability; D008875:Middle Aged; D000070957:MutL Protein Homolog 1 / Q000235:genetics
chemical_list: C501486:MLH1 protein, human; D000070957:MutL Protein Homolog 1