Which Lynch syndrome screening programs could be implemented in the "real world"? A systematic review of economic evaluations

Abstract

Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."

Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.

Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with age-targeted programs with lower age thresholds.

Conclusion: Universal or <70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world."

Figure 1

Flow diagram for selection of economic evaluations of LS screening programs. (Adapted from PRISMA.) CEA Registry, Cost-Effectiveness Analysis Registry; DARE, Database of Abstracts of Reviews of Effects; EconLit, Economics Literature Index; HTA Database, Health Technology Assessment Database; LYG, life-years gained; NHS EED, National Health Service Economic Evaluation Database; QALY, quality-adjusted life-years.