Kansal Anuraag R, Tafazzoli Ali, Shaul Alissa, Chavan Ameya, Ye Weicheng, Zou Denise, Fendrick A Mark
GRAIL, Inc., 1525 O'Brien Dr, Menlo Park, CA 94025. Email:
Am J Manag Care. 2024 Dec 1;30(12):e352-e358. doi: 10.37765/ajmc.2024.89643.
Multicancer early detection (MCED) testing could result in earlier cancer diagnosis, thereby improving survival and reducing treatment costs. This study evaluated the cost-effectiveness of MCED testing plus usual care (UC) screening while accounting for the impact of clinical uncertainty and population heterogeneity for an MCED test with broad coverage of solid cancer incidence.
Cost-effectiveness analysis of MCED testing plus UC vs UC alone in an adult population in the US.
A hybrid cohort-level model compared annual MCED testing plus UC with UC alone in detecting cancer among individuals aged 50 to 79 years over a lifetime horizon from a US payer perspective. Sensitivity and scenario analyses were conducted to explore the impact of key clinical uncertainties and population heterogeneity in valuing MCED, including differential survival by cell-free DNA detectability status, cancer progression rate, and how the test is likely to be implemented in clinical practice.
Among 100,000 individuals, MCED testing plus UC shifted 7200 cancers to earlier stages at diagnosis compared with UC alone, resulting in an additional 0.14 quality-adjusted life-years (QALYs) and $5241 treatment cost savings per person screened and an incremental cost-effectiveness ratio (ICER) of $66,048/QALY gained at $949 test price. Among analyses of clinical uncertainties, differential survival had the greatest impact on cost-effectiveness. In probabilistic sensitivity analyses, MCED testing plus UC was cost-effective in all analyses with a maximum ICER of $91,092/QALY.
Under a range of likely clinical scenarios, MCED testing was estimated to be cost-effective, improving survival and reducing treatment costs.
多癌早期检测（MCED）测试可实现癌症的早期诊断，从而提高生存率并降低治疗成本。本研究评估了MCED测试加常规护理（UC）筛查的成本效益，同时考虑了临床不确定性和人群异质性对广泛覆盖实体癌发病率的MCED测试的影响。
对美国成年人群中MCED测试加UC与单独UC进行成本效益分析。
一个混合队列水平模型从美国支付方的角度比较了终生范围内每年进行MCED测试加UC与单独UC在50至79岁个体中检测癌症的情况。进行了敏感性和情景分析，以探讨关键临床不确定性和人群异质性对MCED评估的影响，包括无细胞DNA可检测状态、癌症进展率的差异生存情况，以及该测试在临床实践中的可能实施方式。
在100,000名个体中，与单独UC相比，MCED测试加UC在诊断时将7200例癌症转移到了更早阶段，每人筛查可额外获得0.14个质量调整生命年（QALY）并节省5241美元的治疗成本，在测试价格为949美元时增量成本效益比（ICER）为66,048美元/QALY。在临床不确定性分析中，差异生存对成本效益影响最大。在概率敏感性分析中，MCED测试加UC在所有分析中均具有成本效益，最大ICER为91,092美元/QALY。
在一系列可能的临床情景下，MCED测试被估计具有成本效益，可提高生存率并降低治疗成本。
