Health Economic Evaluations of Circulating Tumor DNA Testing for Cancer Screening: Systematic Review

Background

Cancer detection remains a significant global healthcare challenge, and circulating tumor DNA (ctDNA) is a biomarker for noninvasive cancer screening.

Objective

This systematic review aimed to describe health economic evaluations of ctDNA for cancer screening.

Methods

A comprehensive literature search was performed (following PRISMA guidelines) across MEDLINE, Embase, APA PsycINFO, Cochrane Library, Web of Science, and the Center for Review and Dissemination. The review included full-scale health economic analyses such as cost–effectiveness, cost–utility, cost–benefit, and cost–consequence analyses. The quality of the included reports was assessed using CHEERS 2022 standards, and each report was categorized as excellent, very good, good, or insufficient.

Results

Eighteen studies were selected, including four ctDNA tests (EBV-DNA, cf-DNA, mSEPT9, and mt-sDNA) for three types of cancer screening: nasopharyngeal carcinoma (NPC) (2; 11.11%), breast cancer (BC) (1; 5.56%), and colorectal cancer (CRC) (15; 83.33%). Five studies (27.78%) found ctDNA cost-effective for CRC screening (mt-sDNA (with higher uptake than conventional tests) versus fecal immunochemical testing (FIT) or colonoscopy (n = 4); mSEPT9 versus computed tomography colonoscopy (CTC) (n = 1)). Thirteen studies (72.22%) found ctDNA not cost-effective for NPC (EBV-DNA versus no screening (n = 2)); BC (cf-DNA versus conventional testing (n = 1)); CRC (mSEPT9 versus FIT or colonoscopy (n = 2)); mt-sDNA versus FIT or colonoscopy (n = 5); mSEPT9 or mt-sDNA versus conventional tests (n = 3)). The CHEERS assessment found all reports in the “very good” category.

Conclusion

All ctDNA tests were generally not cost-effective comparing to conventional screening methods, except when the mt-sDNA uptake was higher than the comparators or when mSEPT9 was compared with CTC.

Trial Registration

CRD42023477732