Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.
J Med Econ. 2024 Jan-Dec;27(1):746-753. doi: 10.1080/13696998.2024.2349467. Epub 2024 May 13.
This analysis estimated the outcomes of triennial blood-based colorectal cancer (CRC) screening at various adherence, including perfect adherence, compared with triennial multi-target stool DNA (mt-sDNA) screening at the reported real-world adherence rate.
The validated CRC-AIM model simulated a US cohort of average-risk individuals receiving triennial screening with mt-sDNA or blood-based test from ages 45 to 75 years. Modeled specificity and sensitivity were based on reported data. Adherence was set at a real-world rate of 65.6% for mt-sDNA and at 65.6%, relative 10% incremental increases from 65.6%, or 100% for the blood-based test. Costs of mt-sDNA and the blood-based test were based on prices for clinically available tests ($508.87 and $895, respectively). Value-based pricing was estimated at a willingness-to-pay threshold of $100,000.
Both tests resulted in life-years gained (LYG), reduced CRC cases, and reduced deaths versus no screening. With adherence for mt-sDNA set at 65.6% and for blood-based test set at 100%, mt-sDNA resulted in 30% more LYG, 52% more averted CRC cases, and 32% more averted CRC deaths. At reported sensitivity and specificity rates, mt-sDNA at 65.6% adherence dominates (is more effective and less costly) the blood-based test at any adherence. There was no price at which triennial screening with the blood-based test at any adherence was cost-effective compared with mt-sDNA at 65.6% adherence.
Triennial screening with mt-sDNA resulted in better clinical outcomes at a lower cost compared with the modeled blood-based test even at perfect adherence, supporting application of blood-based tests only as a secondary screening option.
本分析比较了不同依从性（包括完全依从性）下每三年进行一次基于血液的结直肠癌（CRC）筛查与每三年进行一次基于多靶点粪便 DNA（mt-sDNA）筛查的结果，后者为报告的真实世界依从率。
经过验证的 CRC-AIM 模型模拟了一个美国平均风险人群队列，该队列从 45 岁到 75 岁每三年接受一次 mt-sDNA 或基于血液的检测筛查。模型的特异性和敏感性基于报告的数据。mt-sDNA 的依从性设定为真实世界的 65.6%，而对于基于血液的检测，依从性设定为 65.6%，相对于 65.6%有 10%的递增，或设定为 100%。mt-sDNA 和基于血液的检测的成本基于临床可用检测的价格（分别为 508.87 美元和 895 美元）。基于 100000 美元的支付意愿阈值，对基于价值的定价进行了估计。
与不筛查相比，两种检测方法均使生命年获益（LYG）增加，CRC 病例减少，CRC 死亡减少。如果 mt-sDNA 的依从性设定为 65.6%，而基于血液的检测的依从性设定为 100%，则 mt-sDNA 使 LYG 增加 30%，使避免的 CRC 病例增加 52%，使避免的 CRC 死亡增加 32%。在报告的敏感性和特异性率下，mt-sDNA 在 65.6%的依从性下占主导地位（更有效且成本更低），而任何依从性下的基于血液的检测都不如它。无论依从性如何，基于血液的检测在任何依从性下都没有达到成本效益。
即使在完全依从的情况下，与模拟的基于血液的检测相比，每三年进行一次 mt-sDNA 筛查可带来更好的临床结果，同时成本更低，支持仅将基于血液的检测作为二级筛查选择。
