Cost analysis of biomarker testing for mismatch repair deficiency in node-positive colorectal cancer.

2.50
Hdl Handle:
http://hdl.handle.net/10541/58720
Title:
Cost analysis of biomarker testing for mismatch repair deficiency in node-positive colorectal cancer.
Authors:
Barrow, E; McMahon, R; Evans, D Gareth R; Levine, Edward; Hill, J
Abstract:
BACKGROUND: Microsatellite instability (MSI) in colorectal cancer is caused by defective DNA mismatch repair (MMR). It is present in 15 per cent of sporadic colorectal cancers owing to epigenetic mutL homologue 1 (MLH1) inactivation. The evidence suggests that patients with tumours caused by defective DNA MMR do not benefit from 5-fluorouracil (5-FU)-based chemotherapy. METHODS: The proportion of cancers with defective DNA MMR identified by MSI analysis or immunohistochemistry was calculated from published data. The cost of analysis was compared with the potential savings if 5-FU-based chemotherapy was not administered to these patients. RESULTS: Some 16.3 per cent of sporadic colorectal cancers had defective DNA MMR. Immunostaining for MLH1 and mutS homologue 2 (MSH2) had a sensitivity of 92.4 per cent and a specificity of 99.6 per cent for identifying MSI-high tumours. The strongest predictive variable was right-sidedness, with positive and negative predictive values of 0.329 and 0.948 respectively. If 5-FU-based chemotherapy were not administered, potential savings of up to pound 1.2 million per 1000 patients tested could be made. Costs would be higher if alternative chemotherapeutic regimens were substituted as a result of testing. CONCLUSION: Knowledge of MMR status may enable participation in trials of non-5-FU-based chemotherapy. The cost of MMR testing may be offset by more efficient use of chemotherapy.
Affiliation:
Department of General Surgery, Manchester Royal Infirmary, St Mary's Hospital, Manchester, UK. emma.barrow@doctors.org.uk
Citation:
Cost analysis of biomarker testing for mismatch repair deficiency in node-positive colorectal cancer. 2008, 95 (7):868-75 Br J Surg
Journal:
The British Journal of Surgery
Issue Date:
Jul-2008
URI:
http://hdl.handle.net/10541/58720
DOI:
10.1002/bjs.6172
PubMed ID:
18457354
Type:
Article
Language:
en
ISSN:
1365-2168
Appears in Collections:
All Christie Publications ; Clinical Oncology

Full metadata record

DC FieldValue Language
dc.contributor.authorBarrow, E-
dc.contributor.authorMcMahon, R-
dc.contributor.authorEvans, D Gareth R-
dc.contributor.authorLevine, Edward-
dc.contributor.authorHill, J-
dc.date.accessioned2009-04-01T23:23:31Z-
dc.date.available2009-04-01T23:23:31Z-
dc.date.issued2008-07-
dc.identifier.citationCost analysis of biomarker testing for mismatch repair deficiency in node-positive colorectal cancer. 2008, 95 (7):868-75 Br J Surgen
dc.identifier.issn1365-2168-
dc.identifier.pmid18457354-
dc.identifier.doi10.1002/bjs.6172-
dc.identifier.urihttp://hdl.handle.net/10541/58720-
dc.description.abstractBACKGROUND: Microsatellite instability (MSI) in colorectal cancer is caused by defective DNA mismatch repair (MMR). It is present in 15 per cent of sporadic colorectal cancers owing to epigenetic mutL homologue 1 (MLH1) inactivation. The evidence suggests that patients with tumours caused by defective DNA MMR do not benefit from 5-fluorouracil (5-FU)-based chemotherapy. METHODS: The proportion of cancers with defective DNA MMR identified by MSI analysis or immunohistochemistry was calculated from published data. The cost of analysis was compared with the potential savings if 5-FU-based chemotherapy was not administered to these patients. RESULTS: Some 16.3 per cent of sporadic colorectal cancers had defective DNA MMR. Immunostaining for MLH1 and mutS homologue 2 (MSH2) had a sensitivity of 92.4 per cent and a specificity of 99.6 per cent for identifying MSI-high tumours. The strongest predictive variable was right-sidedness, with positive and negative predictive values of 0.329 and 0.948 respectively. If 5-FU-based chemotherapy were not administered, potential savings of up to pound 1.2 million per 1000 patients tested could be made. Costs would be higher if alternative chemotherapeutic regimens were substituted as a result of testing. CONCLUSION: Knowledge of MMR status may enable participation in trials of non-5-FU-based chemotherapy. The cost of MMR testing may be offset by more efficient use of chemotherapy.en
dc.language.isoenen
dc.subjectColorectal Canceren
dc.subjectCost Analysisen
dc.subject.meshAdaptor Proteins, Signal Transducing-
dc.subject.meshColorectal Neoplasms-
dc.subject.meshCost Savings-
dc.subject.meshCost-Benefit Analysis-
dc.subject.meshDNA Mismatch Repair-
dc.subject.meshGenetic Markers-
dc.subject.meshHumans-
dc.subject.meshImmunohistochemistry-
dc.subject.meshLymphatic Metastasis-
dc.subject.meshMicrosatellite Instability-
dc.subject.meshMutS Homolog 2 Protein-
dc.subject.meshNuclear Proteins-
dc.subject.meshPredictive Value of Tests-
dc.titleCost analysis of biomarker testing for mismatch repair deficiency in node-positive colorectal cancer.en
dc.typeArticleen
dc.contributor.departmentDepartment of General Surgery, Manchester Royal Infirmary, St Mary's Hospital, Manchester, UK. emma.barrow@doctors.org.uken
dc.identifier.journalThe British Journal of Surgeryen

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