Lauren Clarke

An economic viewpoint on alternative strategies for identifying persons with hereditary nonpolyposis colorectal cancer

Purpose There is uncertainty regarding the optimal strategy for identifying mutation carriers among those with hereditary nonpolyposis colorectal cancer (HNPCC).Methods We used decision analysis to compare the cost-effectiveness of 4 strategies among those with newly diagnosed colon cancer: (1) clinical and family history followed by microsatellite instability testing and germline testing (Bethesda guidelines); (2) universal microsatellite instability testing; (3) germline testing of those who meet clinical and family history criteria; and (4) universal germline testing.Results The added cost per year of life saved (YLS) for each strategy was as follows: (1)

Family History Assessment to Detect Increased Risk for Colorectal Cancer: Conceptual Considerations and a Preliminary Economic Analysis

11,865/YLS, (2)

Will knowledge of gene-based colorectal cancer disease risk influence quality of life and screening behavior? Findings from a population-based study.

35,617/YLS, (3)

Colony-Stimulating Factor Use and Impact on Febrile Neutropenia Among Patients with Newly Diagnosed Breast, Colorectal, or Non–Small Cell Lung Cancer Who Were Receiving Chemotherapy

49,702/YLS, and (4)

Cost-effectiveness of microsatellite instability Screening as a method for detecting Hereditary nonpolyposis Colorectal Cancer

267,548/YLS.Conclusions The Bethesda guidelines are the most cost-effectiveness approach to screen persons for HNPCC.

Evaluation of Erlotinib in Advanced Non-Small Cell Lung Cancer: Impact on the Budget of a U.S. Health Insurance Plan

Background: Although the rationale for earlier screening of persons with a family history of colorectal cancer is plausible, there is no direct evidence that earlier assessment is either effective or cost-effective. Objective: To estimate the clinical and economic effect of using family history assessment to identify persons for colorectal cancer screening before age 50. Methods: We developed a decision model to compare costs and outcomes for two scenarios: (a) standard population screening starting at age 50; (b) family history assessment at age 40, followed by screening colonoscopy at age 40 for those with a suggestive family history of colorectal cancer. The analysis was conducted using the health insurer perspective. Results: Using U.S. population estimates, 22 million would be eligible for family history assessment, and one million would be eligible for early colonoscopy; 2,834 invasive cancers would be detected, and 29,331 life years would be gained. The initial program cost would be

Colony-stimulating factor prescribing patterns in patients receiving chemotherapy for cancer.

900 million. The discounted cost per life year gained of family history assessment versus no assessment equals

Is combined androgen blockade with bicalutamide cost-effective compared with combined androgen blockade with flutamide?

58,228. The results were most sensitive to the life expectancy benefit from earlier screening, the cost of colonoscopy, and the relative risk of colon cancer in those with a family history. Conclusions: The cost-effectiveness of family history assessment for colorectal cancer approaches that of other widely accepted technologies; yet, the results are sensitive to several assumptions where better data are needed. Because of the relatively high prevalence of family history in the population, careful analysis and empirical data are needed.

Health Care Use and Primary Prophylaxis with Colony-Stimulating Factors

Background: Several gene variants conveying a modestly increased risk for disease have been described for colorectal cancer. Patient acceptance of gene variant testing in clinical practice is not known. We evaluated the potential impact of hypothetical colorectal-cancer-associated gene variant testing on quality of life, health habits and cancer screening behavior. Methods: First-degree relatives of colorectal cancer patients and controls from the Seattle Colorectal Cancer Familial Registry were invited to participate in a web-based survey regarding testing for gene variants associated with colorectal cancer risk. Results: 310 relatives and 170 controls completed the questionnaire. Quality of life for the hypothetical carrier state was modestly and nonsignificantly lower than current health after adjustment for sociodemographic and health factors. In the positive test scenario, 30% of respondents expressed willingness to change their diet, 25% to increase exercise, and 43% to start colorectal cancer screening. The proportions willing to modify these habits did not differ between groups. Conclusions: Testing for gene variants associated with colorectal cancer risk may not influence quality of life, but may impact health habits and screening adherence. Changing behaviors as a result of testing may help to reduce cancer incidence and mortality, particularly among those at higher risk for colorectal cancer.

Health insurer policies toward risk-stratified colorectal cancer screening: a survey of health plan medical directors.

To determine the impact of primary prophylactic colony‐stimulating factor (CSF) use on febrile neutropenia in a large patient population receiving contemporary chemotherapy regimens to treat breast cancer, colorectal cancer, or non–small cell lung cancer (NSCLC).