YOU HAVE TO SPEND MONEY TO MAKE MONEY (AND SAVE LIVES)- FINANCIAL CASE FOR UNIVERSAL LYNCH SYNDROME TESTING
Vitaliy Poylin*1,2, Scott A. Strong1,2, Mohammad Ali Abbass1,2
1Gastrointestinal Surgery, Northwestern Medicine, Chicago, IL; 2Northwestern University Feinberg School of Medicine, Chicago, IL
Introduction
Universal screening of all colorectal and endometrial cancer patients is used to identify patients with Lynch syndrome. Identification of patients with Lynch syndrome has treatment and surveillance implications for patients and their families. An assessment of National Cancer Institute designated comprehensive cancer programs showed that only 71% are performing universal screening, with cost being one of the major obstacles. Net Present Value (NPV) is a financial tool designed to identify difference between present value of cash inflows and the outflows over time and is used to calculate whenever investment in the new project if financially sound (positive NPV) or not (negative NPV). We hypothesize that investment into universal tumor screening on all newly diagnosed colorectal cancers will generate profit over time.
Methods
A financial model was created based on number of newly diagnosed colorectal cancer patients. We presumed that 1/25 individuals with colorectal cancer have Lynch syndrome. NCCN guidelines were used to identify required surveillance intervals. Cost of testing was presumed to be absorbed by the hospital. Index operations were omitted and only surveillance going forward was used. Charges and discount rates from Northwestern Medcine were used in the calculation
Results
Two hundred new cases of colorectal cancer are expected to be identified at our institution annually. Immunohistochemistry for all four mismatch repair proteins will cost $209 per patient ($52.25 per stain per protein) and $5,000 on pathology technician time per year. In our cohort, 8 new patients (equal number of males and females was presumed) is expected to be identified as having Lynch syndrome. These newly diagnosed individuals will require flexible sigmoidoscopy (presuming recommended resection was performed), EGD, pelvic exam and endometrial ultrasound for female patients and a dermatology visit. Based on current charges, 5-year NPV is positive at $110,000 and 10 year NPV is positive at $199.663. Presuming average size of American family and 50% of siblings and children having the mutation, additional 8 individuals will be identified leading to genetic testing, recurrent colonoscopy, EGD, dermatology appointments and pelvic exams and ultrasounds in females leading to additional 10-year positive NPV of $253,018. NPV remains positive even for institution that sees 25 new colorectal cancers per year.
Conclusion
Financial investment in universal screening on all new cases of colorectal cancer results in a positive NPV and significant profit for the hospital over time. Upfront investment in screening is still profitable even in low volume hospitals. This will also improve quality of care of those patients and allows for personalized care as well especially in the era of immunotherapy.
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