Appendix Table 3.
Assumptions regarding costs. All costs are in 2018 Canadian Dollars.
| Procedure | Costs (Rangea) | Sourceb | ||
|---|---|---|---|---|
| Related to genetic testing | ||||
| Combined costs of lab testing in index CRC case | 224 (112-336) | Ontario Estimate | ||
| IHC MLH1, MSH2/6, PMS2 | 150 | |||
| BRAF V600E mutation | 300 | |||
| Methylation of MLH1 promoter | 400 | |||
| Cost of patient navigator per individual referred to genetic counseling | 108 (54-162) | Ontario Estimatec | ||
| Costs of pre-test genetic counseling in CRC index case | 255 (128-383) | Ontario Estimated | ||
| Avg. cost of germline test in index CRC case | 1,099 (549-1,648) | Ontario Estimatee | ||
| MSH2/6, PMS2 | 1,200 | |||
| MLH1 | 1,040 | |||
| Post-test genetic counseling and tracing FDRs for LS positive cases & Costs of pre-test genetic counseling of FDRs (per index CRC case with LS) & Post-test genetic counseling FDR | 90 (45-135) | Ontario Estimatef | ||
| Somatic testing for LS negative cases | 500 (250-750) | Ontario Estimate | ||
| Costs of germline testing for LS in a FDR with a known mutation | 400 (200-600) | Ontario Estimate | ||
| Related to colonoscopiesg | ||||
| Colonoscopy without polypectomy | 947 (474-1,421) | 18 | ||
| Colonoscopy with polypectomy & Colonoscopy for diagnosis of CRC by symptoms | 1,192 (596-1,788) | 18 | ||
| CRC careh | ||||
| Females (50.7%)i | Stage I | Stage II | Stage III | Stage IV |
| Initial | 29,240 (14,620-58,481) | 42,537 (21,269-85,074) | 63,432 (31,746-126,865) | 80,855 (40,427-161,709) |
| Continuing | 7,664 (3,832-15,328) | 10,155 (5,077-20,310) | 13,269 (6,635-26,539) | 40,423 (20,212-80,846) |
| Terminal, death CRC | 324,973 (162,487-649,947) | 236,714 (118,357-473,429) | 144,521 (72,260-289,041) | 131,414 (65,707-262,828) |
| Terminal, death OC | 31,064 (15,532-62,129) | 29,295 (14,647-58,590) | 30,743 (15,371-61,486) | 28,703 (14,351-57,405) |
| Males (49.3%)i | Stage I | Stage II | Stage III | Stage IV |
| Initial | 33,131 (16,565-66,261) | 50,829 (25,414-101,658) | 70,868 (35,434-141,736) | 90,642 (45,321-181.285) |
| Continuing | 8,386 (4,193-16,773) | 12,292 (6,146-16,773) | 15,442 (7,721-30,884) | 50,015 (25,008-100,030) |
| Terminal, death CRC | 329,770 (164,885-659,539) | 207,153 (103,577-414,307) | 147,150 (73,575-294,299) | 124,025 (62,013-248,050) |
| Terminal, death OC | 33,210 (16,605-66,420) | 49,954 (24,977-99.909) | 36,949 (18,747-73,898) | 34,412 (17,206-68,825) |
CRC= Colorectal cancer, LS= Lynch syndrome, FDR=first-degree relative, OC= other causes.
Alternative values evaluated in sensitivity analyses. Ranges evaluated were mean*0.5 –mean*1.5.
Ontario Estimate: costs are based on experience at the Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital, Toronto, Ontario
Annual salary of a navigator ($70,000) was divided by the estimated number of cases per year (650).
Includes 1 hour Salary for Genetic Counseler ($90) and Ontario Health Insurance Plan (OHIP) Fee Schedule code A225 ($165).
62% of individuals were tested for MLH1.
Includes 1 hour Salary for Genetic Counseler ($90).
Costs of colonoscopy were obtained from the 2013 Ontario Health Insurance Plan (OHIP) Schedule of Benefits and Fees,18 and updated to 2018 Canadian dollars using the consumer price index (CPI; All-items).19 These were varied together in the one-way sensitivity analysis.
CRC care was divided in three clinically relevant phases. The initial care phase was defined as the first 12 months after diagnosis, the terminal care phase as the final 12 months of life, and the continuing care phase as all months in between. For patients surviving less than 24 months, the last 12 months were allocated to the terminal care phase and the remaining months were allocated to the initial care phase.
The costs attributable to CRC care by sex, CRC stage, and phase of care (initial, continuing, and terminal care) included outpatient visits, hospitalizations, treatment, home care, long-term care, and rehabilitation. The costs were estimated using health care administrative data in a matched cohort study, which compared the health care costs of CRC patients with their age- and sex-matched controls,38 and updated to 2018 Canadian dollars using the CPI.19
Based on the 2015 Ontario Population, accounting for the age distribution of the FDRs.