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Early cancer screening cost-effective for patients with Li-Fraumeni syndrome
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Cancer screening in presymptomatic patients with Li-Fraumeni syndrome appeared cost-effective for third-party payers, according to results of a study published in Pediatric Blood and Cancer.
Patients with Li-Fraumeni syndrome — an inherited condition associated with germline pathogenic variants in the key tumor suppressor gene TP53 — have a one-in-two chance of developing cancer by age 30 years and a nearly 100% risk for cancer during their lifetimes, according to a press release.
Previous studies have suggested that tumor surveillance for these patients improves survival by detecting cancer early. However, the potential cost and lack of insurance reimbursement have been obstacles to widespread adoption in the U.S.
“We were able to simulate the costs and benefits of early cancer surveillance vs. standard of care over a lifetime,” Joshua Schiffman, MD, cancer researcher at Huntsman Cancer Institute and professor of pediatrics at The University of Utah, said in the release. “This allowed us to gain a long-term view of the effects that undergoing, or not undergoing, cancer surveillance may have for patients with [Li-Fraumeni syndrome].”
Schiffman and colleagues developed a Markov decision analytic model from a third-party payer perspective to determine the cost-effectiveness of a cancer surveillance strategy for patients with Li-Fraumeni syndrome. The model included four health states: no cancer, cancer, post-cancer survivorship and death. Outcomes included costs in 2015 U.S. dollars; effectiveness in terms of life-years gained; and incremental cost-effectiveness ratio (ICER), based on the resulting costs of surveillance and life-years gained.
The model showed a nonsurveillance strategy had a mean cost of $46,496 and yielded 23 life-years, whereas a cancer surveillance strategy had a mean cost of $117,102 and yielded 27 life-years.
The ICER for surveillance vs. nonsurveillance was $17,125 per additional life-year gained. When measured against the commonly accepted willingness-to-pay threshold of $100,000 per life-year gained, the surveillance strategy had a 98% probability of being the most cost-effective option for early cancer detection for these patients.
Cancer costs used in this study represented the phases of cancer care and not the true treatment costs for early-stage vs. late-stage tumors, which served as a limitation.
“One of the biggest clinical challenges we have with early cancer screenings for our patients [with Li-Fraumeni syndrome] is receiving insurance approval,” Schiffman said in the release “Hopefully, we can use this research to show that not only does early cancer screening save lives, but it is also cost-effective for patients [with Li-Fraumeni syndrome].” – by John DeRosier
Disclosures: The Huntsman Cancer Foundation, Li-Fraumeni Syndrome Association, NCI, Soccer for Hope and The University of Utah funded this study. The authors report no relevant financial disclosures.
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