Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Fred Hutchinson Cancer Center, Seattle, Washington.
JAMA Netw Open. 2023 Nov 1;6(11):e2343392. doi: 10.1001/jamanetworkopen.2023.43392.
Despite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening.
To estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US.
DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy-liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy.
No screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy-liquid biopsy hybrid screening.
Model outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained.
This study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy-liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy-liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly.
In this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.
尽管有普遍筛查的建议，但美国对结直肠癌筛查的依从率约为 60%。液体活检检测正在开发用于癌症早期检测，但尚不清楚其在结直肠癌筛查方面是否具有成本效益。
评估液体活检用于美国结直肠癌筛查的成本效益。
设计、设置和参与者：在这项经济评估中，开发了一个马尔可夫模型来比较无筛查和 5 种结直肠癌筛查策略：结肠镜检查、液体活检、结肠镜检查后不依从的液体活检、粪便 DNA 和粪便免疫化学检测。假设一线筛查采用结肠镜检查、粪便 DNA 或粪便免疫化学检测的依从率为 60.6%，液体活检的依从率假设为 100%。对于结肠镜检查、粪便 DNA 和粪便免疫化学检测，如果患者不遵守检测，将不提供其他筛查。在结肠镜检查-液体活检混合方案中，液体活检是对那些推迟结肠镜检查的人的二线筛查。进行了情景分析，以包括液体活检检测到息肉的可能性。
无筛查、结肠镜检查、粪便免疫化学检测、粪便 DNA 和液体活检以及结肠镜检查-液体活检混合筛查。
模型结果包括预期寿命、总费用和增量成本效益比。如果一种策略的增量成本效益比低于美国每获得 1 个生命年愿意支付的 100000 美元的阈值，则认为该策略具有成本效益。
本研究使用了一个平均结直肠癌风险的 45 岁患者模拟队列。在基础病例中，结肠镜检查是首选或具有成本效益的策略，增量成本效益比为每获得 1 个生命年 28071 美元。结肠镜检查-液体活检混合方案具有最大的生命年获益，但增量成本效益比为 377538 美元。如果液体活检可以检测到息肉，那么结肠镜检查-液体活检混合方案可以获得更多的生命年，但成本仍然过高。
在这项关于液体活检用于结直肠癌筛查的经济评估中，结肠镜检查是普通人群结直肠癌筛查的一种具有成本效益的策略，而将液体活检作为一线或二线筛查策略的纳入在目前的成本和筛查效果下并不具有成本效益。如果液体活检检测的成本大幅降低，其用于结直肠癌筛查可能具有成本效益。
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