Preventive Surgery Cost-Effective in Lynch Syndrome

Prophylactic surgery is both cost-effective and the best treatment for women at risk of endometrial and ovarian cancer due to Lynch syndrome, according to a new study.

Researchers at the University of California at San Francisco (UCSF; USA) developed a mathematic cost model that showed that risk-reducing surgery--hysterectomy with bilateral salpingo-oophorectomy--was more cost-effective than annual screening or routine annual check-ups. The researchers used the Surveillance, Epidemiology and End Results (SEER) database from 1988 to 2001 to estimate mortality and data from UCSF to estimate the costs of care.

The cost model included such factors as screening charges, hospital stays, chemotherapy and radiation, surgery, home health care, and several other factors. Results showed that the cumulative cost of endometrial cancer would be about US$113,000 if the patients died five years after diagnosis, $194,000 if she died 10 years after diagnosis. Even if treatment was successful and the woman was cured, the cost would be about $146,000.
In contrast, the researchers estimated the cost of preventive surgery to be about $11,000.

The researchers expressed their cost-effectiveness findings using discounted life-years, which are a statistical method of standardizing patients' perception of the value of an intervention in terms of life expectancy. On that basis, preventive surgery has a cost per discounted life-year of $954, compared with $2,406 for annual screening and $3,319 for annual check-ups. The study was presented at the Society of Gynecologic Oncologists annual meeting, held in San Diego (CA, USA) during March 2007.

"Over a lifetime, annual screening was about 2.5 times as expensive as preventive surgery at age 30, and routine check-ups were about 3.5 times as expensive,” said lead author Lee-May Chen, M.D. "A combination of colectomy, hysterectomy, and bilateral salpingo-oophorectomy would provide a lot of peace of mind. If you've eliminated [the risk of] colon cancer, endometrial cancer, and ovarian cancer, you've eliminated the top three.”

Lynch syndrome--also known as hereditary non-polyposis colorectal cancer--affects one woman in 2,000. Women with the syndrome have a lifetime risk of endometrial cancer that is in the range of 40-60%, compared with 2% in the general population. At the same time, their risk of ovarian cancer ranges from 5%-12%, compared with between 1% and 2% in the general population.


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