PRECISIONheor, Boston, MA, USA.
Exact Sciences Corporation, Madison, WI, USA.
J Med Econ. 2021 Jan-Dec;24(1):69-78. doi: 10.1080/13696998.2020.1858607.
To examine the impact of increasing multi-target stool DNA test (mt-sDNA [Cologuard]) utilization for colorectal cancer (CRC) screening in cohorts aged 50-75 and 45-75 years old with varying levels of adherence from the perspectives of integrated delivery networks (IDNs) and payers.
We developed a budget impact model that simulates CRC screening with colonoscopy over a 10-year time horizon, fecal immunochemical test (FIT), and mt-sDNA according to the United States Preventive Services Task Force and American Cancer Society guidelines for average risk adults. We evaluated varying levels of screening adherence for a status quo scenario and for an increased mt-sDNA utilization scenario, from the IDN and payer perspectives. The IDN perspective included CRC screening program costs, whereas the payer perspective did not. Conversely, stool-based screening test and bowel preparation costs were unique to the payer perspective.
The increased mt-sDNA scenarios yielded cost savings relative to the status quo under all adherence scenarios due to a decrease in screening and surveillance colonoscopies. For ages 50-75, in high and low adherence scenarios, savings were $19.8 M ($0.16 per-person-per-month (PPPM)) and $33.3 M ($0.28 PPPM) from the IDN perspective. From the payer perspective, savings were $4.2 M ($0.03 PPPM) and $6.7 M ($0.06 PPPM). For ages 45-75, in high and low adherence scenarios, cost savings were $19.3 M ($0.16 PPPM) and $33.0 M ($0.28 PPPM) from the IDN perspective and $3.9 M ($0.03 PPPM) and $6.2 M ($0.05 PPPM) from the payer perspective. In all imperfect adherence scenarios, the degree of cost-savings with increased mt-sDNA utilization correlated with the aggregate decrease in screening and surveillance colonoscopies.
Estimates of real-world adherence levels were based on cross-sectional screening data from the literature, and assumptions were applied to individual screening modalities and screening scenarios.
Among all adherence scenarios, perspectives, and age ranges, increased mt-sDNA utilization yielded cost-savings.
从综合医疗服务网络（IDN）和支付方的角度，考察在不同依从水平的 50-75 岁和 45-75 岁人群中，增加多靶点粪便 DNA 检测（mt-sDNA [Cologuard]）用于结直肠癌（CRC）筛查对 CRC 筛查的影响。
我们开发了一个预算影响模型，根据美国预防服务工作组和美国癌症协会的平均风险成年人筛查指南，在 10 年的时间范围内模拟结肠镜检查、粪便免疫化学试验（FIT）和 mt-sDNA 的 CRC 筛查。我们从 IDN 和支付方的角度评估了现状和增加 mt-sDNA 使用情况下不同水平的筛查依从性。IDN 视角包括 CRC 筛查项目成本，而支付方视角则不包括。相反，基于粪便的筛查试验和肠道准备成本仅对支付方视角是独特的。
在所有依从性情景下，由于筛查和监测结肠镜检查的减少，增加 mt-sDNA 的情景相对于现状产生了成本节约。对于 50-75 岁的人群，在高和低依从性情景下，从 IDN 的角度来看，节省了 1980 万美元（每人每月 0.16 美元（0.16 美元））和 3330 万美元（0.28 美元）。从支付方的角度来看，节省了 420 万美元（0.03 美元）和 670 万美元（0.06 美元）。对于 45-75 岁的人群，在高和低依从性情景下，从 IDN 的角度来看，节省了 1930 万美元（每人每月 0.16 美元）和 3300 万美元（0.28 美元），从支付方的角度来看，节省了 390 万美元（0.03 美元）和 620 万美元（0.05 美元）。在所有不完全依从性情景下，增加 mt-sDNA 使用率的成本节约程度与筛查和监测结肠镜检查的总减少量相关。
真实世界依从水平的估计基于文献中的横断面筛查数据，并应用于个体筛查方式和筛查情景。
在所有依从性情景、视角和年龄范围内，增加 mt-sDNA 的使用都带来了成本节约。
