{"title":"新型无创结直肠癌筛查方法的成本-效果分析","authors":"Mingjun Rui, Yingcheng Wang, Joyce H S You","doi":"10.1158/1055-9965.EPI-24-1549","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>To compare cost-effectiveness of three novel noninvasive tests [multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0, and cell-free DNA] with guideline-recommended tests for colorectal cancer screening from payer's perspective.</p><p><strong>Methods: </strong>Outcomes of a hypothetical cohort of 100,000 individuals aged 45 years with average colorectal cancer risk (no prior colorectal cancer diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of colorectal cancer) in the United States 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, and multitarget stool DNA), three novel noninvasive 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 (QALY), and incremental cost-effectiveness ratios (ICER).</p><p><strong>Results: </strong>All screening strategies (vs. no screening) reduced colorectal cancer cases and deaths. In the perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER = US$261/QALY). In the 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 colorectal cancer prevalence, progression rate, and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in the test-specific adherence scenario at a willingness to pay US $100,000/QALY.</p><p><strong>Conclusions: </strong>All strategies were cost-effective compared with no screening. Every-3-year mt-sRNA (preferred strategy in the real-world adherence scenario) provides a cost-effective alternative when adherence to colorectal cancer 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 noninvasive tests versus all guideline-recommended colorectal cancer screening tests. See related In the Spotlight, p. 1053.</p>","PeriodicalId":9458,"journal":{"name":"Cancer Epidemiology Biomarkers & Prevention","volume":" ","pages":"1111-1121"},"PeriodicalIF":3.4000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Novel Noninvasive Tests for Colorectal Cancer Screening - A Cost-Effectiveness Analysis.\",\"authors\":\"Mingjun Rui, Yingcheng Wang, Joyce H S You\",\"doi\":\"10.1158/1055-9965.EPI-24-1549\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>To compare cost-effectiveness of three novel noninvasive tests [multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0, and cell-free DNA] with guideline-recommended tests for colorectal cancer screening from payer's perspective.</p><p><strong>Methods: </strong>Outcomes of a hypothetical cohort of 100,000 individuals aged 45 years with average colorectal cancer risk (no prior colorectal cancer diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of colorectal cancer) in the United States 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, and multitarget stool DNA), three novel noninvasive 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 (QALY), and incremental cost-effectiveness ratios (ICER).</p><p><strong>Results: </strong>All screening strategies (vs. no screening) reduced colorectal cancer cases and deaths. In the perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER = US$261/QALY). In the 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 colorectal cancer prevalence, progression rate, and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in the test-specific adherence scenario at a willingness to pay US $100,000/QALY.</p><p><strong>Conclusions: </strong>All strategies were cost-effective compared with no screening. Every-3-year mt-sRNA (preferred strategy in the real-world adherence scenario) provides a cost-effective alternative when adherence to colorectal cancer 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 noninvasive tests versus all guideline-recommended colorectal cancer screening tests. See related In the Spotlight, p. 1053.</p>\",\"PeriodicalId\":9458,\"journal\":{\"name\":\"Cancer Epidemiology Biomarkers & Prevention\",\"volume\":\" \",\"pages\":\"1111-1121\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-07-01\",\"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}","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}
Novel Noninvasive Tests for Colorectal Cancer Screening - A Cost-Effectiveness Analysis.
Background: To compare cost-effectiveness of three novel noninvasive tests [multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0, and cell-free DNA] with guideline-recommended tests for colorectal cancer screening from payer's perspective.
Methods: Outcomes of a hypothetical cohort of 100,000 individuals aged 45 years with average colorectal cancer risk (no prior colorectal cancer diagnosis, adenomatous polyps, or other disorders associated with a high lifetime risk of colorectal cancer) in the United States 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, and multitarget stool DNA), three novel noninvasive 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 (QALY), and incremental cost-effectiveness ratios (ICER).
Results: All screening strategies (vs. no screening) reduced colorectal cancer cases and deaths. In the perfect adherence scenario, every-10-year colonoscopy was the preferred strategy (ICER = US$261/QALY). In the 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 colorectal cancer prevalence, progression rate, and utility were influential factors. Every-3-year mt-sRNA showed the highest probability (37.6%) to be cost-effective in the test-specific adherence scenario at a willingness to pay US $100,000/QALY.
Conclusions: All strategies were cost-effective compared with no screening. Every-3-year mt-sRNA (preferred strategy in the real-world adherence scenario) provides a cost-effective alternative when adherence to colorectal cancer screening or follow-up was not perfect in clinical practice.
Impact: This is the first study to demonstrate cost-effectiveness of novel noninvasive tests versus all guideline-recommended colorectal cancer screening tests. See related In the Spotlight, p. 1053.
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.