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Cost-Effectiveness of the Manchester Approach to Identifying Lynch Syndrome in Women with Endometrial Cancer

1
Health Economics Group, University of Exeter Medical School, Exeter EX1 2LU, UK
2
Division of Evolution and Genomic Medicine, University of Manchester, St Mary’s Hospital, Manchester M13 9WL, UK
3
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary’s Hospital, Manchester M13 9WL, UK
4
Academic Centre for Women’s Health, University of Bristol, Bristol BS8 2PS, UK
5
Division of Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1664; https://doi.org/10.3390/jcm9061664
Received: 25 April 2020 / Revised: 21 May 2020 / Accepted: 22 May 2020 / Published: 1 June 2020
(This article belongs to the Special Issue Genetic Epidemiology of Inherited Cancers)
Lynch syndrome (LS) is a hereditary cancer syndrome responsible for 3% of all endometrial cancer and 5% in those aged under 70 years. It is unclear whether universal testing for LS in endometrial cancer patients would be cost-effective. The Manchester approach to identifying LS in endometrial cancer patients uses immunohistochemistry (IHC) to detect mismatch repair (MMR) deficiency, incorporates testing for MLH1 promoter hypermethylation, and incorporates genetic testing for pathogenic MMR variants. We aimed to assess the cost-effectiveness of the Manchester approach on the basis of primary research data from clinical practice in Manchester. The Proportion of Endometrial Tumours Associated with Lynch Syndrome (PETALS) study informed estimates of diagnostic performances for a number of different strategies. A recent microcosting study was adapted and was used to estimate diagnostic costs. A Markov model was used to predict long-term costs and health outcomes (measured in quality-adjusted life years, QALYs) for individuals and their relatives. Bootstrapping and probabilistic sensitivity analysis were used to estimate the uncertainty in cost-effectiveness. The Manchester approach dominated other reflex testing strategies when considering diagnostic costs and Lynch syndrome cases identified. When considering long-term costs and QALYs the Manchester approach was the optimal strategy, costing £5459 per QALY gained (compared to thresholds of £20,000 to £30,000 per QALY commonly used in the National Health Service (NHS)). Cost-effectiveness is not an argument for restricting testing to younger patients or those with a strong family history. Universal testing for Lynch syndrome in endometrial cancer patients is expected to be cost-effective in the U.K. (NHS), and the Manchester approach is expected to be the optimal testing strategy. View Full-Text
Keywords: Lynch syndrome; endometrial cancer; reflex testing; cost-effectiveness analysis; decision analytic model Lynch syndrome; endometrial cancer; reflex testing; cost-effectiveness analysis; decision analytic model
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MDPI and ACS Style

Snowsill, T.M.; Ryan, N.A.J.; Crosbie, E.J. Cost-Effectiveness of the Manchester Approach to Identifying Lynch Syndrome in Women with Endometrial Cancer. J. Clin. Med. 2020, 9, 1664. https://doi.org/10.3390/jcm9061664

AMA Style

Snowsill TM, Ryan NAJ, Crosbie EJ. Cost-Effectiveness of the Manchester Approach to Identifying Lynch Syndrome in Women with Endometrial Cancer. Journal of Clinical Medicine. 2020; 9(6):1664. https://doi.org/10.3390/jcm9061664

Chicago/Turabian Style

Snowsill, Tristan M.; Ryan, Neil A.J.; Crosbie, Emma J. 2020. "Cost-Effectiveness of the Manchester Approach to Identifying Lynch Syndrome in Women with Endometrial Cancer" J. Clin. Med. 9, no. 6: 1664. https://doi.org/10.3390/jcm9061664

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