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Cost effectiveness of a new strategy to identify HNPCC patients
  1. W Kievit1,
  2. J H F M de Bruin2,
  3. E M M Adang1,
  4. J L Severens7,
  5. J H Kleibeuker9,
  6. R H Sijmons10,
  7. T J Ruers4,
  8. F M Nagengast5,
  9. H F A Vasen8,
  10. J H J M van Krieken3,
  11. M J L Ligtenberg2,3,
  12. N Hoogerbrugge2,6
  1. 1Department of Medical Technology Assessment, University Medical Centre Nijmegen, the Netherlands
  2. 2Department of Human Genetics, University Medical Centre Nijmegen, the Netherlands
  3. 3Department of Pathology, University Medical Centre Nijmegen, the Netherlands
  4. 4Department of Surgery, University Medical Centre Nijmegen, the Netherlands
  5. 5Department of Gasteroenterology, University Medical Centre Nijmegen, the Netherlands
  6. 6Department of Medical Oncology, University Medical Centre Nijmegen, the Netherlands
  7. 7Department of Health Organization, Policy, and Economics, University Maastricht, the Netherlands
  8. 8The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden University Medical Centre, the Netherlands
  9. 9Department of Gastroenterology and Hepatology, University Hospital Groningen, the Netherlands
  10. 10Department of Medical Genetics, University Hospital Groningen, the Netherlands
  1. Correspondence to:
    Dr N Hoogerbrugge
    University Medical Centre Nijmegen, 417 Human Genetics, PO Box 9101, 6500 HB Nijmegen, the Netherlands;


Background: Distinguishing hereditary non-polyposis colorectal cancer (HNPCC) from non-hereditary colorectal cancer (CRC) can increase the life expectancy of HNPCC patients and their close relatives.

Aim: To determine the effectiveness, efficiency, and feasibility of a new strategy for the detection of HNPCC, using simple criteria for microsatellite instability (MSI) analysis of newly detected tumours that can be applied by pathologists. Criteria for MSI analysis are: (1) CRC before age 50 years; (2) second CRC; (3) CRC and HNPCC associated cancer; or (4) adenoma before age 40 years.

Methods: The efficacy and cost effectiveness of the new strategy was evaluated against current practice. Decision analytic models were constructed to estimate the number of extra HNPCC mutation carriers and the costs of this strategy. The incremental costs and gain in life expectancy for a HNPCC mutation carrier were evaluated by Markov modelling. Feasibility was explored in five hospitals.

Results: Using the new strategy, 2.2 times more HNPCC patients can be identified among a CRC population compared with current practice. This new strategy was found to be cost effective with an expected cost effectiveness ratio of €3801 per life year gained. When including the group of siblings and children, the cost effectiveness ratio became €2184 per life year gained. Sensitivity analysis showed these findings to be robust.

Conclusions: MSI testing in a selection of newly diagnosed CRC patients was shown to be cost effective and a feasible method to identify patients at risk for HNPCC who are not recognised by family history.

  • HNPCC, hereditary non-polyposis colorectal cancer
  • CRC, colorectal cancer
  • MMR genes, mismatch repair genes
  • MSI, microsatellite instability
  • colorectal cancer
  • microsatellite instability
  • cost effectiveness
  • genetic testing

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