GRAIL LLC, a subsidiary of Illumina Inc., 1525 O'Brien Drive, Menlo Park, CA, 94025, USA.
Evidence Synthesis, Modeling & Communication, Evidera Inc. (at time of study), Bethesda, MD, USA.
Pharmacoeconomics. 2022 Nov;40(11):1107-1117. doi: 10.1007/s40273-022-01181-3. Epub 2022 Aug 30.
Multi-cancer early detection (MCED) testing could increase detection of cancer at early stages, when survival outcomes are better and treatment costs are lower, but is expected to increase screening costs. This study modeled an MCED test for 19 solid cancers in a US population and estimated the potential value-based price (the maximum price to meet a given willingness to pay) of the MCED test plus current single cancer screening (usual care) compared to usual care alone from a third-party payer perspective over a lifetime horizon.
A hybrid cohort-level state-transition and decision-tree model was developed to estimate the clinical and economic outcomes of annual MCED testing between age 50 and 79 years. The impact on time and stage of diagnosis was computed using an interception modeling approach, with the consequences of cancer modeled based on stage at diagnosis. The model parameters were mainly sourced from the literature, including a published case-control study to inform MCED test performance. All costs were inflated to 2021 US dollars.
Multi-cancer early detection testing shifted cancer diagnoses to earlier stages, with a 53% reduction in stage IV cancer diagnoses, resulting in longer overall survival compared with usual care. Addition of MCED decreased per cancer treatment costs by $5421 and resulted in a gain of 0.13 and 0.38 quality-adjusted life-years across all individuals in the screening program and those diagnosed with cancer, respectively. At a willingness-to-pay threshold of $100,000 per quality-adjusted life-year gained, the potential value-based price of an MCED test was estimated at $1196. The projected survival of individuals diagnosed with cancer and the number of cancers detected at an earlier stage by MCED had the greatest impact on outcomes.
An MCED test with high specificity would potentially improve long-term health outcomes and reduce cancer treatment costs, resulting in a value-based price of $1196 at a $100,000/quality-adjusted life-year willingness-to-pay threshold.
多癌种早期检测（MCED）测试可以提高癌症早期的检出率，此时生存结果更好，治疗费用更低，但预计会增加筛查成本。本研究对美国人群中 19 种实体瘤的 MCED 测试进行了建模，并从第三方支付者的角度评估了 MCED 测试加当前单一癌症筛查（常规护理）相对于单独常规护理在终身范围内的潜在基于价值的价格（满足特定支付意愿的最高价格）。
我们开发了一种混合队列水平的状态转换和决策树模型，用于估计 50 至 79 岁人群中每年进行 MCED 测试的临床和经济结果。使用截距建模方法计算对诊断时间和阶段的影响，基于诊断时的阶段对癌症的后果进行建模。模型参数主要来源于文献，包括一项用于提供 MCED 测试性能信息的已发表病例对照研究。所有成本均按 2021 年的美元进行了通胀调整。
MCED 检测将癌症诊断提前到更早的阶段，IV 期癌症诊断减少了 53%，与常规护理相比，总生存期更长。添加 MCED 使每位癌症治疗成本降低了 5421 美元，并使整个筛查计划中的每个人和诊断出癌症的人分别获得了 0.13 和 0.38 个质量调整生命年。在 10 万美元/QALY 的支付意愿阈值下，MCED 测试的潜在基于价值的价格估计为 1196 美元。诊断出癌症的个体的预期生存时间和 MCED 更早检测到的癌症数量对结果的影响最大。
特异性高的 MCED 测试可能会改善长期健康结果并降低癌症治疗成本，在 10 万美元/QALY 的支付意愿阈值下，其基于价值的价格为 1196 美元。
