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

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.