ArticleDigestive diseases and sciences2014
Cost-effectiveness and diagnostic effectiveness analyses of multiple algorithms for the diagnosis of Lynch syndrome.
Article in Digestive diseases and sciences, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Clinical Implications of Mismatch Repair Deficiency in Pancreatic Ductal Adenocarcinoma.Cancer medicine · 2025Review
- Universal tumor screening for lynch syndrome on colorectal cancer biopsies impacts surgical treatment decisions.Familial cancer · 2023Article
- Fertility-sparing treatment for endometrial cancer and atypical endometrial hyperplasia in patients with Lynch Syndrome: Molecular diagnosis after immunohistochemistry of MMR proteins.Frontiers in medicine · 2022Article
- Cost-effective screening using a two-antibody panel for detecting mismatch repair deficiency in sporadic colorectal cancer.World journal of clinical cases · 2021Article
- The Clinicopathological Characteristics and Prognoses of dMMR Gastric Adenocarcinoma Patients.Gastroenterology research and practice · 2021Article
- Germline mismatch repair gene variants analyzed by universal sequencing in Japanese cancer patients.Cancer medicine · 2019Article
- Mismatch Repair/Microsatellite Instability Testing Practices among US Physicians Treating Patients with Advanced/Metastatic Colorectal Cancer.Journal of clinical medicine · 2019Article
- Patterns of family communication and preferred resources for sharing information among families with a Lynch syndrome diagnosis.Patient education and counseling · 2018Article
- Article
- Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations.Cost effectiveness and resource allocation : C/E · 2018Review
- Universal Versus Targeted Screening for Lynch Syndrome: Comparing Ascertainment and Costs Based on Clinical Experience.Digestive diseases and sciences · 2016Article
- Combined Microsatellite Instability, MLH1 Methylation Analysis, and Immunohistochemistry for Lynch Syndrome Screening in Endometrial Cancers From GOG210: An NRG Oncology and Gynecologic Oncology Group Study.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2015Article
- Evolving approach and clinical significance of detecting DNA mismatch repair deficiency in colorectal carcinoma.Seminars in diagnostic pathology · 2015Review
- Screening for Lynch syndrome: it is time to shift the focus.Digestive diseases and sciences · 2015Article
- When is Genomic Testing Cost-Effective? Testing for Lynch Syndrome in Patients with Newly-Diagnosed Colorectal Cancer and Their Relatives.Healthcare (Basel, Switzerland) · 2015Article
- Identifying persons with Lynch syndrome: why and how?Digestive diseases and sciences · 2014Article
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5 authors.
Funding
Abstract
BACKGROUND AND
aimsThe optimal algorithm to identify Lynch syndrome (LS) among patients with colorectal cancer (CRC) is unclear. The definitive test for LS, germline testing, is too expensive to be applied in all cases. Initial screening with the revised Bethesda Guidelines (RBG) cannot be applied in a considerable number of cases due to missing information.
methodsWe developed a model to evaluate the cost-effectiveness of 10 strategies for diagnosing LS. Three main issues are addressed: modeling estimates (20-40%) of RBG applicability; comparing sequential or parallel use of microsatellite instability (MSI) and immunohistochemistry (IHC); and a threshold analysis of the charge value below which universal germline testing becomes the most cost-effective strategy.
resultsLS detection rates in RBG-based strategies decreased to 64.1-70.6% with 20% inapplicable RBG. The strategy that uses MSI alone had lower yield, but also lower cost than strategies that use MSI sequentially or in parallel with IHC. The use of MSI and IHC in parallel was less affected by variations in the sensitivity and specificity of these tests. Universal germline testing had the highest yield and the highest cost of all strategies. The model estimated that if charges for germline testing drop to $633-1,518, universal testing of all newly diagnosed CRC cases becomes the most cost-effective strategy.
conclusionsThe low applicability of RBG makes strategies employing initial laboratory-based testing more cost-effective. Of these strategies, parallel testing with MSI and IHC offers the most robust yield. With a considerable drop in cost, universal germline testing may become the most cost-effective strategy for the diagnosis of LS.
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