OBJECTIVES

Colorectal cancer (CRC) is a fatal disease with an increasing incidence in Asian countries. one of the most important risk factors for this disease is lynch syndrome. Identifying Lynch syndrome (LS) in patients with colorectal cancer (CRC) and monitoring their relatives can increase the life expectancy of their close relatives. The aim of this study is to analyze the cost-effectiveness of five molecular testing strategies to screen LS among the patients with newly diagnosed CRC and conducting preventive surveillance in their first-degree relatives.

METHODS

A decision tree model was designed to identify the number of LS mutations and related costs in CRC patients. In doing this, five strategies were modeled i.e. Amsterdam II criteria, microsatellite instability (MSI) testing, immunohistochemistry (IHC) and next-generation sequencing (NGS). A Marko model was used to estimate the long term outcome of monitoring (including colonoscopy and taking aspirin) among the relative of those patients with CRC who carry LS. Costs from a health system perspective and Quality-adjusted life years (QALYs) and life-years gained in relatives were estimated over a lifetime horizon and discounted at 3% per annum.

RESULTS

All strategies were cost-effective when compared with no testing. The two most cost-effective strategies were strategy 2 (IHC testing followed by NGS testing) and strategy 4 (MSI testing, followed by NGS testing) with ICER of 4,604 $ and 4,748 $ per QALY, respectively.

CONCLUSIONS

Our finding suggested that from an Iranian health care system perspective, IHC testing followed by NGS testing is the most cost-effective strategy compared to the other strategies. These results will be useful for offering to screen LS in newly diagnosed CRC patients.