Comparing the Cost-Effectiveness of Innovative Colorectal Cancer Screening Tests

Overview

Journal J Natl Cancer Inst

Publisher Oxford University Press

Specialty Oncology

Date 2020 Aug 8

PMID 32761199

Citations 36

Authors

Elisabeth F P Peterse

Reinier G S Meester

Lucie de Jonge

Amir-Houshang Omidvari

Fernando Alarid-Escudero

Amy B Knudsen

Ann G Zauber

Iris Lansdorp-Vogelaar

Affiliations

Soon will be listed here.

Abstract

Background: Colorectal cancer (CRC) screening with colonoscopy and the fecal immunochemical test (FIT) is underused. Innovative tests could increase screening acceptance. This study determined which of the available alternatives is most promising from a cost-effectiveness perspective.

Methods: The previously validated Microsimulation Screening Analysis-Colon model was used to evaluate the cost-effectiveness of screening with capsule endoscopy every 5 or 10 years, computed tomographic colonography every 5 years, the multi-target stool DNA test every 1 or 3 years, and the methylated SEPT9 DNA plasma assay (mSEPT9) every 1 or 2 years. We also compared these strategies with annual FIT screening and colonoscopy screening every 10 years. Quality-adjusted life-years gained (QALYG), number of colonoscopies, and incremental cost-effectiveness ratios were projected. We assumed a willingness-to-pay threshold of $100 000 per QALYG.

Results: Among the alternative tests, computed tomographic colonography every 5 years, annual mSEPT9, and annual multi-target stool DNA screening had incremental cost-effectiveness ratios of $1092, $63 253, and $214 974 per QALYG, respectively. Other screening strategies were more costly and less effective than (a combination of) these 3. Under the assumption of perfect adherence, annual mSEPT9 screening resulted in more QALYG, CRC cases averted, and CRC deaths averted than annual FIT screening but led to a high rate of colonoscopy referral (51% after 3 years, 69% after 5 years). The alternative tests were not cost-effective compared with FIT and colonoscopy.

Conclusions: This study suggests that for individuals not willing to participate in FIT or colonoscopy screening, mSEPT9 is the test of choice if the high colonoscopy referral rate is acceptable to them.

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References

Lo S, Halloran S, Snowball J, Seaman H, Wardle J, von Wagner C . Predictors of repeat participation in the NHS bowel cancer screening programme. Br J Cancer. 2014; 112(1):199-206. PMC: 4453613. DOI: 10.1038/bjc.2014.569. View

Hassan C, Zullo A, Winn S, Morini S . Cost-effectiveness of capsule endoscopy in screening for colorectal cancer. Endoscopy. 2008; 40(5):414-21. DOI: 10.1055/s-2007-995565. View

Wolf A, Fontham E, Church T, Flowers C, Guerra C, LaMonte S . Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018; 68(4):250-281. DOI: 10.3322/caac.21457. View

Sanders G, Neumann P, Basu A, Brock D, Feeny D, Krahn M . Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine. JAMA. 2016; 316(10):1093-103. DOI: 10.1001/jama.2016.12195. View

Lieberman D, Rex D, Winawer S, Giardiello F, Johnson D, Levin T . Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143(3):844-857. DOI: 10.1053/j.gastro.2012.06.001. View

Schroy 3rd P, Coe A, Chen C, OBrien M, Heeren T . Prevalence of advanced colorectal neoplasia in white and black patients undergoing screening colonoscopy in a safety-net hospital. Ann Intern Med. 2013; 159(1):13-20. PMC: 4218749. DOI: 10.7326/0003-4819-159-1-201307020-00004. View

Meester R, Peterse E, Knudsen A, de Weerdt A, Chen J, Lietz A . Optimizing colorectal cancer screening by race and sex: Microsimulation analysis II to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018; 124(14):2974-2985. PMC: 6055229. DOI: 10.1002/cncr.31542. View

Baio G . BCEA: A R Package to Perform Bayesian Cost-Effectiveness Analysis. Value Health. 2016; 17(7):A550. DOI: 10.1016/j.jval.2014.08.1793. View

Peterse E, Meester R, Gini A, Doubeni C, Anderson D, Berger F . Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries. Health Aff (Millwood). 2017; 36(12):2151-2159. PMC: 6067012. DOI: 10.1377/hlthaff.2017.0228. View

10.

Rex D, Adler S, Aisenberg J, Burch Jr W, Carretero C, Chowers Y . Accuracy of capsule colonoscopy in detecting colorectal polyps in a screening population. Gastroenterology. 2015; 148(5):948-957.e2. DOI: 10.1053/j.gastro.2015.01.025. View

11.

Lansdorp-Vogelaar I, M Kuntz K, Knudsen A, Wilschut J, Zauber A, van Ballegooijen M . Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis. Ann Intern Med. 2010; 153(6):368-77. PMC: 3578600. DOI: 10.7326/0003-4819-153-6-201009210-00004. View

12.

Neumann P, Cohen J, Weinstein M . Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014; 371(9):796-7. DOI: 10.1056/NEJMp1405158. View

13.

Johnson C, Chen M, Toledano A, Heiken J, Dachman A, Kuo M . Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008; 359(12):1207-17. PMC: 2654614. DOI: 10.1056/NEJMoa0800996. View

14.

Knudsen A, Zauber A, Rutter C, Naber S, Doria-Rose V, Pabiniak C . Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA. 2016; 315(23):2595-609. PMC: 5493310. DOI: 10.1001/jama.2016.6828. View

15.

Ladabaum U, Mannalithara A . Comparative Effectiveness and Cost Effectiveness of a Multitarget Stool DNA Test to Screen for Colorectal Neoplasia. Gastroenterology. 2016; 151(3):427-439.e6. DOI: 10.1053/j.gastro.2016.06.003. View

16.

Siegel R, Fedewa S, Anderson W, Miller K, Ma J, Rosenberg P . Colorectal Cancer Incidence Patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017; 109(8). PMC: 6059239. DOI: 10.1093/jnci/djw322. View

17.

Ahmed D, Danielsen S, Aagesen T, Bretthauer M, Thiis-Evensen E, Hoff G . A tissue-based comparative effectiveness analysis of biomarkers for early detection of colorectal tumors. Clin Transl Gastroenterol. 2013; 3:e27. PMC: 3535074. DOI: 10.1038/ctg.2012.21. View

18.

van Rijn J, Reitsma J, Stoker J, Bossuyt P, van Deventer S, Dekker E . Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006; 101(2):343-50. DOI: 10.1111/j.1572-0241.2006.00390.x. View

19.

Simon J . Occult blood screening for colorectal carcinoma: a critical review. Gastroenterology. 1985; 88(3):820-37. DOI: 10.1016/0016-5085(85)90158-1. View

20.

Meissner H, Klabunde C, Breen N, Zapka J . Breast and colorectal cancer screening: U.S. primary care physicians' reports of barriers. Am J Prev Med. 2012; 43(6):584-9. DOI: 10.1016/j.amepre.2012.08.016. View