Abstract
Background and Objectives: Genetic testing and counseling for the patients with HNPCC (hereditary nonpolyposis colorectal cancer) are changing the cancer prevention strategies. However, the clinical evidence is still insufficient to make screening policy for at‐risk carriers. In our study, while clarifying the economic effects/merits of genetic testing to HNPCC, the most appropriate age to start the screening from the viewpoint of health economics is presumed.
Materials and Methods: We developed systems model of colon cancer treatment along with Markov model, after sorting complicated clinical course of treatment by type. In the model, we presumed that the close relatives of the patient with HNPCC have genetic screening and continue undergoing the colonoscopic examination once a year afterward. We incorporated patients' data such as the cumulative morbidity of HNPCC, accumulated on the study groups of Japan into the systems model. When delaying cancer death by the intervention of genetic screening, the differences of the increment of the labor productivity of the prolonged period and that of the expense spent for the prevention and treatment is computed as an economic effect of cancer prevention.
Results and Discussion: The expense of genetic screening and endoscopy were $612 and $1,020 respectively. The stage distribution at the detection of colon cancer was as follows; I 36.8%, II 31.1%, III 19.2% and IV 12.9%. The utility value was assumed to be 0.8 in cost‐utility analysis. In case of the male relative of the patient with HNPCC, the cost‐benefit differences of genetic testing became large, if he would have genetic screening in his twenties. Hence, it became clear that genetic screening in younger age would have not a little meaning from cancer‐economic point of view. Supposing he continued the examination in diagnostic phase in case of positive male, five‐year survival rate after colon cancer treatment was as good as younger age when he underwent the genetic testing. In case of female, the rate of recovery is as good as younger age as well, but the cost‐benefit differences became its maximum at her thirties rather twenties.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):B37.
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