Population-Based Newborn Screening for Germline TP53 Variants: Clinical Benefits, Cost-Effectiveness, and Value of Further Research

• Published in: JNCI : Journal of the National Cancer Institute Vol. 114; no. 5; pp. 722 - 731
• Main Authors: Kunst, Natalia, Stout, Natasha K, O’Brien, Grace, Christensen, Kurt D, McMahon, Pamela M, Wu, Ann Chen, Diller, Lisa R, Yeh, Jennifer M
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 09.05.2022; Oxford Publishing Limited (England)
• Subjects: Cancer; Child; Cost analysis; Cost-Benefit Analysis; Data analysis; Early Detection of Cancer; Epidemiology; Germ Cells; Humans; Infant; Infant, Newborn; Information management; Li-Fraumeni syndrome; Li-Fraumeni Syndrome - diagnosis; Li-Fraumeni Syndrome - epidemiology; Li-Fraumeni Syndrome - genetics; Malignancy; Medical screening; Neonatal Screening; Neonates; Pediatrics; Population-based studies; Probabilistic analysis; Rhabdomyosarcoma; Statistical analysis; Surveillance; Tumor Suppressor Protein p53 - genetics; Tumors; Uncertainty; Young Adult
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djac013

Abstract Background Identification of children and infants with Li-Fraumeni syndrome prompts tumor surveillance and allows potential early cancer detection. We assessed the clinical benefits and cost-effectiveness of population-wide newborn screening for TP53 variants (TP53-NBS). Methods We simulated the impact of TP53-NBS using data regarding TP53-associated pediatric cancers and pathogenic or likely pathogenic (P/LP) TP53 variants from Surveillance, Epidemiology, and End Results; ClinVar and gnomAD; and clinical studies. We simulated an annual US birth cohort under usual care and TP53-NBS and estimated clinical benefits, life-years, and costs associated with usual care and TP53-NBS. Results Under usual care, of 4 million newborns, 608 (uncertainty interval [UI] = 581-636) individuals would develop TP53-associated cancers before age 20 years. Under TP53-NBS, 894 individuals would have P/LP TP53 variants detected. These individuals would undergo routine surveillance after detection of P/LP TP53 variants decreasing the number of cancer-related deaths by 7.2% (UI = 4.0%-12.1%) overall via early malignancy detection. Compared with usual care, TP53-NBS had an incremental cost-effectiveness ratio of $106 009 per life-year gained. Probabilistic analysis estimated a 40% probability that TP53-NBS would be cost-effective given a $100 000 per life-year gained willingness-to-pay threshold. Using this threshold, a value of information analysis found that additional research on the prevalence of TP53 variants among rhabdomyosarcoma cases would resolve most of the decision uncertainty, resulting in an expected benefit of 349 life-years gained (or $36.6 million). Conclusions We found that TP53-NBS could be cost-effective; however, our findings suggest that further research is needed to reduce the uncertainty in the potential health outcomes and costs associated with TP53-NBS.