Economic evaluation of genetic screening for XXXX in Germany.

@entity1 @entity4309 @entity5 @entity14 @entity817 @entity7634
PURPOSE: @entity4309 ( @entity4309 ) screening among @entity1 with newly diagnosed @entity14 can decrease mortality in their affected first-degree relatives. In Germany, it is not yet clinical practice and the cost-effectiveness of different testing strategies is unknown. METHODS: We developed a decision-analytic model to analyze the cost-effectiveness of @entity4309 screening from the perspective of the German Statutory Health Insurance system. A total of 22 testing strategies considering family-history assessment, analysis of @entity5 samples (i.e., immunohistochemistry (IHC), microsatellite instability, and @entity817 mutation testing) and genetic sequencing were analyzed. Life-years gained in relatives by closed-meshed colonoscopy and aspirin prophylaxis were estimated by Markov models. Uncertainty was assessed deterministically and probabilistically. RESULTS: On average, detected mutation carriers gained 0.52 life-years (undiscounted: 1.34) by increased prevention. Most strategies were dominated, with three exceptions: family assessment by the Bethesda criteria followed by IHC and @entity817 testing and genetic sequencing; IHC and @entity817 testing and genetic sequencing; and direct sequencing of all index @entity1 . Their incremental cost-effectiveness was [ @entity7634 ]77,268, [ @entity7634 ]253,258, and [ @entity7634 ]4,188,036 per life-year gained, respectively. CONCLUSION: The results were less favorable than those of previous models. Chemoprevention appears to provide comparably low additional benefit and improves cost-effectiveness only slightly.
