A cost‐effectiveness analysis of colorectal screening for hereditary nonpolyposis colorectal carcinoma gene carriers

BACKGROUND It has been estimated that the prevalence of carriers of a mutated mismatch repair (MMR) gene among the general population in Western countries is between 5 and 50 per 10,000. These carriers have a risk of >85% of developing colorectal carcinoma (CRC) and therefore need careful follow‐up. The objective of this study was to analyze the cost‐effectiveness of CRC surveillance for carriers of a mutated MMR gene. METHODS The authors constructed a model to estimate the potential health effects (life expectancy) and healthcare costs of two strategies: 1) surveillance, with colonoscopy every 2‐3 years, and 2) no CRC surveillance. Estimates of the lifetime risk of developing CRC and the stage distribution of CRC for symptomatic patients were derived from the Dutch hereditary nonpolyposis colorectal carcinoma (HNPCC) registry. The CRC stage specific relative survival rates and the effectiveness of surveillance in preventing or detecting cancer early were based on Finnish studies. The costs of surveillance and treatment were derived from recent American studies. RESULTS The results showed that 1) surveillance of gene carriers led to an increase in life expectancy of 7 years, and 2) the costs of surveillance under a wide range of assumptions are less than the costs of no CRC surveillance. CONCLUSIONS CRC surveillance of HNPCC gene carriers appears to be effective and considerably less costly than no CRC surveillance and therefore deserves to be supported by governmental agencies and health insurance organizations. Cancer 1998;82:1632‐7. © 1998 American Cancer Society. Colorectal surveillance of hereditary nonpolyposis colorectal carcinoma gene carriers is effective and considerably less costly than no colorectal surveillance; therefore, it deserves to be supported by governmental agencies and health insurance organizations.