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

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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.

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Acknowledgements

We thank Dr. Jonathan Terdiman, Amie Blanco, and Peggy Conrad for feedback regarding the model. Each author contributed his/her personal time in this project and there is no funding source involved.

Conflict of interest

There is no conflict of interests involving any of the authors in this project.

Ethics approval

No IRB approval required for this project involving a theoretical patient population.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, 1600 Divisadero St. 4th Floor, San Francisco, CA, 94115-1702, USA

    Kathleen Y. Yang & Lee-May Chen

  2. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA

    Aaron B. Caughey

  3. Department of Obstetrics, Gynecology, and Reproductive Sciences, Brigham and Women’s Hospital, Boston, MA, USA

    Sarah E. Little

  4. Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA

    Michael K. Cheung

Authors
  1. Kathleen Y. Yang
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  2. Aaron B. Caughey
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  3. Sarah E. Little
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  4. Michael K. Cheung
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  5. Lee-May Chen
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Corresponding author

Correspondence to Kathleen Y. Yang.

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Yang, K.Y., Caughey, A.B., Little, S.E. et al. A cost-effectiveness analysis of prophylactic surgery versus gynecologic surveillance for women from hereditary non-polyposis colorectal cancer (HNPCC) Families. Familial Cancer 10, 535–543 (2011). https://doi.org/10.1007/s10689-011-9444-z

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  • DOI: https://doi.org/10.1007/s10689-011-9444-z

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