Abstract
Aim
Multi-target stool DNA (mt-sDNA) and fecal immunochemical testing (FIT) are home-based options for colorectal cancer (CRC) screening. Next-generation mt-sDNA has enhanced sensitivity for CRC and advanced precancerous lesions compared with FIT and is not subject to the same capacity constraints as colonoscopy. This analysis evaluated the economic and clinical implications of increasing the proportional utilization of next-generation mt-sDNA.Methods
A budget impact model was developed from the validated CRC-AIM microsimulation model. The model simulated a cohort of 1 M average-risk, screen-eligible adults over a 3-year time horizon from an integrated delivery network perspective. The status quo scenario assumed an initial utilization of 20% next-generation mt-sDNA, 20% FIT, and 60% colonoscopy screening. In a hypothetical increased next-generation mt-sDNA scenario, its utilization expanded to 35% within 3 years, while FIT and colonoscopy utilization decreased to 15% and 50%, respectively. Test performance characteristics, real-world adherence, and cost inputs (i.e. screening test and programs, colonoscopy adverse events, CRC treatment) were derived from published literature. Multiple scenario analyses were conducted.Results
Among 1 M members, total costs in the status quo scenario were $1.058B and with increased next-generation mt-sDNA use were $1.046B, generating an estimated savings of $12.5 M (-$0.35 per member per month). Increasing next-generation mt-sDNA improved the CRC screening rate by 1.1%. Overall, 10,467 fewer screening colonoscopies and 1,912 more follow-up colonoscopies after a positive stool-based test were performed. An additional 17 CRCs were screening-detected, 11 fewer were clinically detected, and there was one less CRC-related death. Increased next-generation mt-sDNA utilization remained cost-saving with all scenario analyses.Conclusions
In this budget impact model, shifting a small proportion of current FIT and colonoscopy utilization to next-generation mt-sDNA for average-risk CRC screening is estimated to be cost-saving. Increasing the next-generation mt-sDNA utilization also improves the screening rate and clinical outcomes while optimizing availability of capacity-limited colonoscopy resources.