A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families

Kathleen Y. Yang, Aaron Caughey, Sarah E. Little, Michael K. Cheung, Lee May Chen

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Women at risk for Lynch Syndrome/HNPCC have an increased lifetime risk of endometrial and ovarian cancer. This study investigates the cost-effectiveness of prophylactic surgery versus surveillance in women with Lynch Syndrome. A decision analytic model was designed incorporating key clinical decisions and existing probabilities, costs, and outcomes from the literature. Clinical forum where risk-reducing surgery and surveillance were considered. A theoretical population of women with Lynch Syndrome at age 30 was used for the analysis. A decision analytic model was designed comparing the health outcomes of prophylactic hysterectomy with bilateral salpingo-oophorectomy at age 30 versus annual gynecologic screening versus annual gynecologic exam. The literature was searched for probabilities of different health outcomes, results of screening modalities, and costs of cancer diagnosis and treatment. Cost-effectiveness expressed in dollars per discounted life-years. Risk-reducing surgery is the least expensive option, costing $23,422 per patient for 25.71 quality-adjusted life-years (QALYs). Annual screening costs $68,392 for 25.17 QALYs; and annual examination without screening costs $100,484 for 24.60 QALYs. Further, because risk-reducing surgery leads to both the lowest costs and the highest number of QALYs, it is a dominant strategy. Risk-reducing surgery is the most cost-effective option from a societal healthcare cost perspective.

Original languageEnglish (US)
Pages (from-to)535-543
Number of pages9
JournalFamilial Cancer
Volume10
Issue number3
DOIs
StatePublished - Sep 2011

Fingerprint

Gynecologic Surgical Procedures
Cost-Benefit Analysis
Colorectal Neoplasms
Quality-Adjusted Life Years
Hereditary Nonpolyposis Colorectal Neoplasms
Costs and Cost Analysis
Health
Ovariectomy
Endometrial Neoplasms
Hysterectomy
Health Care Costs
Ovarian Neoplasms
Population
Neoplasms

Keywords

  • Cost-effectiveness analysis
  • Decision analysis
  • Hereditary non-polyposis colorectal cancer
  • Lynch Syndrome
  • Quality of life
  • Risk-reducing surgery

ASJC Scopus subject areas

  • Cancer Research
  • Genetics
  • Oncology
  • Genetics(clinical)

Cite this

A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families. / Yang, Kathleen Y.; Caughey, Aaron; Little, Sarah E.; Cheung, Michael K.; Chen, Lee May.

In: Familial Cancer, Vol. 10, No. 3, 09.2011, p. 535-543.

Research output: Contribution to journalArticle

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