{"title":"Novel non-invasive tests for colorectal cancer screening - A cost-effectiveness analysis.","authors":"Mingjun Rui, Yingcheng Wang, Joyce Hs You","doi":"10.1158/1055-9965.EPI-24-1549","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To compare cost-effectiveness of 3 novel non-invasive tests (multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0 (mt-sDNA 2.0), and cell-free DNA (cf-DNA)) with guideline-recommended tests for colorectal cancer (CRC) screening from payer's perspective.</p><p><strong>Methods: </strong>Outcomes of a hypothetical cohort of 100,000 individuals aged 45-year-old with average CRC risk (no prior CRC diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of CRC) in the US were simulated by a lifelong Markov model. Screening strategies included: Guideline-recommended strategies (colonoscopy, flexible sigmoidoscopy, computed tomographic colonography, fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood testing, multitarget stool DNA), 3 novel non-invasive tests, and no screening. Scenario analyses on perfect (100%) and test-specific adherence (reported real-world adherence) were conducted. Outcomes included direct cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).</p><p><strong>Results: </strong>All screening strategies (versus no screening) reduced CRC cases and deaths. In perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER=US$261/QALY). In test-specific adherence scenario, every-3-year mt-sRNA was the preferred cost-effective strategy (ICER=US$95,250/QALY). Testing cost, performance, adherence, and CRC prevalence, progression rate and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in test-specific adherence scenario at willingness-to-pay US$100,000/QALY.</p><p><strong>Conclusions: </strong>All strategies were cost-effective compared to no screening. Every-3-year mt-sRNA (preferred strategy in real-world adherence scenario) provides a cost-effective alternative when adherence to CRC screening or follow-up was not perfect in clinical practice.</p><p><strong>Impact: </strong>This is the first study to demonstrate cost-effectiveness of novel non-invasive tests versus all guideline-recommended CRC screening tests.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Epidemiology Biomarkers & Prevention","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1158/1055-9965.EPI-24-1549","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: To compare cost-effectiveness of 3 novel non-invasive tests (multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0 (mt-sDNA 2.0), and cell-free DNA (cf-DNA)) with guideline-recommended tests for colorectal cancer (CRC) screening from payer's perspective.
Methods: Outcomes of a hypothetical cohort of 100,000 individuals aged 45-year-old with average CRC risk (no prior CRC diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of CRC) in the US were simulated by a lifelong Markov model. Screening strategies included: Guideline-recommended strategies (colonoscopy, flexible sigmoidoscopy, computed tomographic colonography, fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood testing, multitarget stool DNA), 3 novel non-invasive tests, and no screening. Scenario analyses on perfect (100%) and test-specific adherence (reported real-world adherence) were conducted. Outcomes included direct cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs).
Results: All screening strategies (versus no screening) reduced CRC cases and deaths. In perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER=US$261/QALY). In test-specific adherence scenario, every-3-year mt-sRNA was the preferred cost-effective strategy (ICER=US$95,250/QALY). Testing cost, performance, adherence, and CRC prevalence, progression rate and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in test-specific adherence scenario at willingness-to-pay US$100,000/QALY.
Conclusions: All strategies were cost-effective compared to no screening. Every-3-year mt-sRNA (preferred strategy in real-world adherence scenario) provides a cost-effective alternative when adherence to CRC screening or follow-up was not perfect in clinical practice.
Impact: This is the first study to demonstrate cost-effectiveness of novel non-invasive tests versus all guideline-recommended CRC screening tests.
期刊介绍：
Cancer Epidemiology, Biomarkers & Prevention publishes original peer-reviewed, population-based research on cancer etiology, prevention, surveillance, and survivorship. The following topics are of special interest: descriptive, analytical, and molecular epidemiology; biomarkers including assay development, validation, and application; chemoprevention and other types of prevention research in the context of descriptive and observational studies; the role of behavioral factors in cancer etiology and prevention; survivorship studies; risk factors; implementation science and cancer care delivery; and the science of cancer health disparities. Besides welcoming manuscripts that address individual subjects in any of the relevant disciplines, CEBP editors encourage the submission of manuscripts with a transdisciplinary approach.
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