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Cost-Utility Analysis of Universal Lynch Syndrome Screening among Colorectal Cancer Patients in a Low-Middle-Income Country

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  • 작성일자

    2026-02-19 18:04

  • 조회수

    13

  • Issue Date

    2025-12

  • Type

    Article
Authors
 Huynh, Cong Bang  ;  Kim, Changsoo  ;  Lam, Nien Vinh  ;  Ung, Van Viet 
Citation
 YONSEI MEDICAL JOURNAL, Vol.66(12) : 816-825, 2025-12 
Journal Title
YONSEI MEDICAL JOURNAL
ISSN
 0513-5796 
Issue Date
2025-12
MeSH
Adult ; Colorectal Neoplasms* / diagnosis ; Colorectal Neoplasms* / economics ; Colorectal Neoplasms* / genetics ; Colorectal Neoplasms, Hereditary Nonpolyposis* / diagnosis ; Colorectal Neoplasms, Hereditary Nonpolyposis* / economics ; Colorectal Neoplasms, Hereditary Nonpolyposis* / genetics ; Cost-Benefit Analysis* ; Decision Trees ; Developing Countries ; Early Detection of Cancer* / economics ; Early Detection of Cancer* / methods ; Female ; Humans ; Immunohistochemistry ; Male ; Markov Chains ; Mass Screening* / economics ; Middle Aged ; Quality-Adjusted Life Years ; Vietnam
Keywords
Colorectal cancer ; Lynch syndrome ; universal screening ; cost-utility analysis ; lower-middle-income countries ; Vietnam
Abstract
Purpose: Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC). While screening for LS is recommended in Western countries, limited economic evaluations exist in lower-middle-income countries such as Vietnam, where CRC incidence is rapidly increasing. This study assessed the cost-utility of universal LS screening in Vietnam from the healthcare system's perspective. Materials and Methods: We developed a decision-analytic model integrating decision trees and Markov models to compare the cost-effectiveness of three strategies: no screening, universal immunohistochemistry (IHC) followed by germline testing, and germline testing without prior tumor analysis. Cost data were derived from Vietnamese healthcare sources, and outcomes were measured in quality-adjusted life years (QALYs). To assess parameter uncertainty, we conducted both one-way sensitivity analysis and probabilistic sensitivity analysis. Results: Universal LS screening was found to be highly cost-effective. Universal germline testing identified the most LS CRC patients (n=742), followed by universal IHC testing (n=646). Compared to no screening, the incremental cost-effectiveness ratios were 47615038 VND/QALY (1904 USD/QALY) for germline testing and 126095537 VND/QALY (5043 USD/QALY) for IHC. Key influential variables included LS prevalence, CRC risk in LS carriers, the proportion of relatives with LS accepting increased surveillance, the acceptance rate of LS testing among relatives, and germline testing cost. Conclusion: All LS screening strategies for CRC patients are cost-effective within the Vietnamese health system, with germline testing being the most favorable. These findings support the inclusion of LS screening in health policies, even in resource-limited settings such as Vietnam.
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DOI
10.3349/ymj.2024.0352
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chang Soo(김창수) ORCID logo https://orcid.org/0000-0002-5940-5649
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/210063
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