Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 5;31(12):2157-2168.
doi: 10.1158/1055-9965.EPI-22-0019.

Cost-Effectiveness of Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors Treated with Procarbazine and/or Infradiaphragmatic Radiotherapy

Berbel L M Ykema #  1 , Andrea Gini #  2 , Lisanne S Rigter  1 , Manon C W Spaander  3 , Leon M G Moons  4 , Tanya M Bisseling  5 , Jan Paul de Boer  6 , Wieke H M Verbeek  1 , Pieternella J Lugtenburg  7 , Cecile P M Janus  8 , Eefke J Petersen  9 , Judith M Roesink  10 , Richard W M van der Maazen  11 ; DICHOS study group; Berthe M P Aleman  12 , Gerrit A Meijer  13 , Flora E van Leeuwen  14 , Petur Snaebjornsson  13 , Beatriz Carvalho  13 , Monique E van Leerdam  1   15 , Iris Lansdorp-Vogelaar #  2
Affiliations

Cost-Effectiveness of Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors Treated with Procarbazine and/or Infradiaphragmatic Radiotherapy

Berbel L M Ykema et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy (IRT) and/or procarbazine have an increased risk of developing colorectal cancer. We investigated the cost-effectiveness of colorectal cancer surveillance in Dutch Hodgkin lymphoma survivors to determine the optimal surveillance strategy for different Hodgkin lymphoma subgroups.

Methods: The Microsimulation Screening Analysis-Colon model was adjusted to reflect colorectal cancer and other-cause mortality risk in Hodgkin lymphoma survivors. Ninety colorectal cancer surveillance strategies were evaluated varying in starting and stopping age, interval, and modality [colonoscopy, fecal immunochemical test (FIT, OC-Sensor; cutoffs: 10/20/47 μg Hb/g feces), and multi-target stool DNA test (Cologuard)]. Analyses were also stratified per primary treatment (IRT and procarbazine or procarbazine without IRT). Colorectal cancer deaths averted (compared with no surveillance) and incremental cost-effectiveness ratios (ICER) were primary outcomes. The optimal surveillance strategy was identified assuming a willingness-to-pay threshold of €20,000 per life-years gained (LYG).

Results: Overall, the optimal surveillance strategy was annual FIT (47 μg) from age 45 to 70 years, which might avert 70% of colorectal cancer deaths in Hodgkin lymphoma survivors (compared with no surveillance; ICER:€18,000/LYG). The optimal surveillance strategy in Hodgkin lymphoma survivors treated with procarbazine without IRT was biennial FIT (47 μg) from age 45 to 70 years (colorectal cancer mortality averted 56%; ICER:€15,000/LYG), and when treated with IRT and procarbazine, annual FIT (47 μg) surveillance from age 40 to 70 was most cost-effective (colorectal cancer mortality averted 75%; ICER:€13,000/LYG).

Conclusions: Colorectal cancer surveillance in Hodgkin lymphoma survivors is cost-effective and should commence earlier than screening occurs in population screening programs. For all subgroups, FIT surveillance was the most cost-effective strategy.

Impact: Colorectal cancer surveillance should be implemented in Hodgkin lymphoma survivors.

PubMed Disclaimer

Figures

Figure 1. Simulated and expected adenoma prevalence and relative risks for colorectal cancer (compared with average risk individuals) among Hodgkin lymphoma (HL) survivors. This figure represents the validation of the data of HL survivors against published data for the entire cohort (A), HL survivors treated with procarbazine without IRT (B) and HL survivors treated with IRT and procarbazine (C). Simulated outcomes were computed assuming no surveillance.
Figure 1.
Simulated and expected adenoma prevalence and relative risks for colorectal cancer (compared with average risk individuals) among Hodgkin lymphoma (HL) survivors. This figure represents the validation of the data of HL survivors against published data for the entire cohort (A), HL survivors treated with procarbazine without IRT (B) and HL survivors treated with IRT and procarbazine (C). Simulated outcomes were computed assuming no surveillance.
Figure 2. Colorectal cancer (CRC) deaths and total costs per 1,000 Hodgkin lymphoma (HL) survivors aged 35 years old in 2019 under different surveillance scenarios. The CRC deaths and the total costs per 1,000 HL survivors are shown for the three subgroups of HL survivors (A and B, respectively). The figures display the different optimal surveillance strategies for the entire cohort, HL survivors treated with procarbazine without IRT and HL survivors treated with IRT and procarbazine. The different colors represent the most optimal surveillance strategies for the different HL subgroups as determined in Table 2. Optimal colonoscopy surveillance strategies were determined in Supplementary Tables 7–10. A willingness-to-pay threshold of €20,000 per LYG was assumed in determining the optimal surveillance strategy in each group. COL, colonoscopy.
Figure 2.
Colorectal cancer (CRC) deaths and total costs per 1,000 Hodgkin lymphoma (HL) survivors aged 35 years old in 2019 under different surveillance scenarios. The CRC deaths and the total costs per 1,000 HL survivors are shown for the three subgroups of HL survivors (A and B, respectively). The figures display the different optimal surveillance strategies for the entire cohort, HL survivors treated with procarbazine without IRT and HL survivors treated with IRT and procarbazine. The different colors represent the most optimal surveillance strategies for the different HL subgroups as determined in Table 2. Optimal colonoscopy surveillance strategies were determined in Supplementary Tables 7–10. A willingness-to-pay threshold of €20,000 per LYG was assumed in determining the optimal surveillance strategy in each group. COL, colonoscopy.
Figure 3. Efficient frontier with efficient surveillance strategies for Hodgkin lymphoma (HL) survivors. In this efficient frontier displays the LYG from CRC surveillance against the total costs per 1,000 euro. Total costs and LYG from surveillance were discounted (3% discounting rate) and 100% adherence was assumed for surveillance and diagnostic test. The optimal surveillance strategies are labelled an indicated by arrows. The efficient frontier is shown separately for the entire cohort (A), HL survivors treated with procarbazine chemotherapy without IRT (B), and HL survivors treated with IRT and procarbazine chemotherapy (C). CRC, colorectal cancer.
Figure 3.
Efficient frontier with efficient surveillance strategies for Hodgkin lymphoma (HL) survivors. In this efficient frontier displays the LYG from CRC surveillance against the total costs per 1,000 euro. Total costs and LYG from surveillance were discounted (3% discounting rate) and 100% adherence was assumed for surveillance and diagnostic test. The optimal surveillance strategies are labelled an indicated by arrows. The efficient frontier is shown separately for the entire cohort (A), HL survivors treated with procarbazine chemotherapy without IRT (B), and HL survivors treated with IRT and procarbazine chemotherapy (C). CRC, colorectal cancer.
See this image and copyright information in PMC

Comment in

References

    1. van Eggermond AM, Schaapveld M, Janus CP, de Boer JP, Krol AD, Zijlstra JM, et al. Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors. Br J Cancer 2017;117:306–14. - PMC - PubMed
    1. Schaapveld M, Aleman BM, van Eggermond AM, Janus CP, Krol AD, van der Maazen RW, et al. Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma. N Engl J Med 2015;373:2499–511. - PubMed
    1. Swerdlow AJ, Higgins CD, Smith P, Cunningham D, Hancock BW, Horwich A, et al. Second cancer risk after chemotherapy for Hodgkin's lymphoma: a collaborative British cohort study. J Clin Oncol 2011;29:4096–104. - PubMed
    1. Hodgson DC, Gilbert ES, Dores GM, Schonfeld SJ, Lynch CF, Storm H, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma. J Clin Oncol 2007;25:1489–97. - PubMed
    1. Stoop EM, de Haan MC, de Wijkerslooth TR, Bossuyt PM, van Ballegooijen M, Nio CY, et al. Participation and yield of colonoscopy versus non-cathartic CT colonography in population-based screening for colorectal cancer: a randomized controlled trial. Lancet Oncol 2012;13:55–64. - PubMed

Publication types