Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population. (1st January 2021)

• Record Type: Journal Article
• Authors: Fisher, Deborah A.; Karlitz, Jordan J.; Jeyakumar, Sushanth; Smith, Nathaniel; Limburg, Paul; Lieberman, David; Fendrick, A. Mark
• Is Part Of: Journal of medical economics. Volume 24:Number 1(2021)
• Page Start: 654
• Page End: 664
• Publication Date: 2021-01-01
• Subjects: CRC-AIM -- cost-effectiveness analysis -- colorectal cancer screening -- simulation model -- early detection of cancer -- colorectal neoplasms -- patient adherence; I12 -- C69; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2021.1922240
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aim: Multiple screening strategies are guideline-endorsed for average-risk colorectal cancer (CRC). The impact of real-world adherence rates on the cost-effectiveness of non-invasive stool-based CRC screening strategies remains undefined. Methods: This cost-effectiveness analysis from the perspective of Medicare as a primary payer used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC–AIM) to estimate cost and clinical outcomes for triennial multi-target stool DNA (mt-sDNA), annual fecal immunochemical test (FIT) and annual fecal occult blood test (FOBT) screening strategies in a simulated cohort of US adults aged 65 years, who were assumed to either be previously unscreened or initiating screening upon entry to Medicare. Reported real-world adherence rates for initial stool-based screening and colonoscopy follow up (after a positive stool test result) were defined as 71.1% and 73.0% for mt-sDNA, 42.6% and 47.0% for FIT, and 33.4% and 47.0% for FOBT, respectively. The incremental cost-effectiveness ratio using quality-adjusted life years (QALY) was defined as the primary outcome of interest; other cost and clinical outcomes were also reported in secondary analyses. Multiple sensitivity and scenario analyses were conducted. Results: When reported real-world adherence rates were included only for initial stool-based screening, mt-sDNA was cost-effective versus FIT ($62, 814/QALY) and FOBT ($39, 171/QALY); mt-sDNA also yielded improved clinical outcomes. When reported real-world adherence rates were included for both initial stool-based screening and follow-up colonoscopy (when indicated), mt-sDNA was increasingly cost-effective compared to FIT and FOBT ($31, 725/QALY and $28, 465/QALY, respectively), with further improved clinical outcomes. Limitations: Results are based on real-world cross-sectional adherence rates and may vary in the context of other types of settings. Only guideline-recommended stool-based strategies were considered in this analysis. Conclusion: Comparisons of the effectiveness and benefits of specific CRC screening strategies should include both test-specific performance characteristics and real-world adherence to screening tests and, when indicated, follow-up colonoscopy.