Hathway Joanne M, Miller-Wilson Lesley-Ann, Sharma Abhishek, Jensen Ivar S, Yao Weiyu, Raza Sajjad, Parks Philip D, Weinstein Milton C
PRECISIONheor, Precision Value & Health, Boston, MA, USA.
Exact Sciences Corporation, Madison, WI, USA.
J Mark Access Health Policy. 2021 Sep 1;9(1):1948670. doi: 10.1080/20016689.2021.1948670. eCollection 2021.
In the United States (US), colorectal cancer (CRC) is the second leading cause of cancer-related deaths. With the majority of the US population covered by employer-based health plans, employers can play a critical role in increasing CRC screening adherence, which may help avert CRC-related deaths. Therefore, it is important for self-insured employers to consider the impact of appropriate utilization of CRC screening options. To evaluate the impact of increasing multitarget stool DNA [mt-sDNA (Cologuard®)] use among CRC screeners from the perspective of a US self-insured employer. A 5-year Markov model was developed to quantify the budget impact of increasing mt-sDNA from 6% to 15% among average-risk screeners using colonoscopy, fecal immunological test, and mt-sDNA. Data on direct medical costs were obtained from published literature, Medicare CPT codes, and the Healthcare cost and Utilization project. Indirect costs included productivity loss due to workplace absenteeism for CRC screening and treatment. With a hypothetical population of 100,000 employees with screeners aged 50-64 years, compared to status quo, increased mt-sDNA utilization resulted in no differences in the numbers of cancers detected and the overall direct and indirect cost savings were ~$214,000 ($0.04 per-employee-per-month) over 5 years. Most of the savings were due to a reduction in the direct medical expenditure related to CRC screening, adverse events, and productivity loss due to colonoscopy screening. Similar results were observed in the model simulation among screeners aged 45-64 years. Increased utilization of mt-sDNA for CRC screening averts direct and indirect medical costs from a self-insured US employer perspective.
在美国，结直肠癌（CRC）是癌症相关死亡的第二大主要原因。由于美国大多数人口都参加了雇主提供的健康保险计划，雇主在提高CRC筛查依从性方面可以发挥关键作用，这可能有助于避免与CRC相关的死亡。因此，对于自保雇主来说，考虑适当使用CRC筛查选项的影响非常重要。从美国自保雇主的角度评估增加多靶点粪便DNA [mt-sDNA（Cologuard®）] 在CRC筛查者中的使用所产生的影响。开发了一个5年马尔可夫模型，以量化在使用结肠镜检查、粪便免疫检测和mt-sDNA的平均风险筛查者中，将mt-sDNA的使用比例从6%提高到15%所产生的预算影响。直接医疗成本数据来自已发表的文献、医疗保险CPT代码以及医疗成本和利用项目。间接成本包括因CRC筛查和治疗而导致的工作场所缺勤造成的生产力损失。假设有10万名年龄在50 - 64岁的员工接受筛查，与现状相比，增加mt-sDNA的使用在检测到的癌症数量上没有差异，并且在5年期间总体直接和间接成本节省约为21.4万美元（每人每月0.04美元）。大部分节省是由于与CRC筛查、不良事件以及结肠镜检查筛查导致的生产力损失相关的直接医疗支出减少。在45 - 64岁筛查者的模型模拟中也观察到了类似结果。从美国自保雇主的角度来看，增加mt-sDNA用于CRC筛查可避免直接和间接医疗成本。
