Effectiveness of a mailed fecal immunochemical test outreach: a Medicare Advantage pilot study

Issaka, Rachel B.; Akinsoto, Nkem; Strait, Erica; Chaudhari, Van; Flum, David R.; Inadomi, John M.

doi:10.1177/1756284820945388

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…Despite this difference in settings, the adherence rates for FIT and FOBT used in the base case scenario are conservative when compared with other reported adherence rates in other non-Medicare populations, ranging from 14%-29% [38,41,44]. Few data also exist on reported real world adherence data for follow-up colonoscopies [41,45].…”

Section: Accepted Manuscript Discussionmentioning

confidence: 97%

“…This is consistent with a previous study that found that when mt-sDNA was offered to Medicare patients previously nonadherent with CRC screening, 88% completed mt-sDNA tests within 12 months and, of those with a positive mt-sDNA test, 96% went on to complete a follow-up colonoscopy [39]. Though mt-sDNA is currently the only stool-based strategy with fully integrated patient navigation, other studies, including a systematic review, have noted that the use of patient navigation and patient reminders are associated with increased adherence to CRC screening across various modalities, including FIT [37,40,41]. Other differences in the practical aspects of stool-based screening strategies may also contribute to test-specific variations in adherence to follow-up colonoscopies.…”

Section: Accepted Manuscript Discussionmentioning

confidence: 99%

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Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population

Fisher

Karlitz

Jeyakumar³

et al. 2021

Journal of Medical Economics

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Aim: Multiple screening strategies are guideline-endorsed for average-risk colorectal cancer (CRC). The impact of real-world adherence rates on the cost-effectiveness of non-invasive stoolbased CRC screening strategies remains undefined.Methods: This cost-effectiveness analysis from the perspective of Medicare as a primary payer used the Colorectal Cancer and Adenoma Incidence and Mortality Microsimulation Model (CRC-AIM) to estimate cost and clinical outcomes for triennial multi-target stool DNA (mt-sDNA), annual fecal immunochemical test (FIT) and annual fecal occult blood test (FOBT) screening strategies in a simulated cohort of U.S. adults aged 65 years, who were assumed to either be previously unscreened or initiating screening upon entry to Medicare. Reported real-world adherence rates for initial stool-based screening and colonoscopy follow up (after a positive stool test result) were defined as 71.1% and 73.0% for mt-sDNA, 42.6% and 47.0% for FIT, and 33.4% and 47.0% for FOBT, respectively. The incremental cost-effectiveness ratio using qualityadjusted life years (QALY) was defined as the primary outcome of interest; other cost and clinical outcomes were also reported in secondary analyses. Multiple sensitivity and scenario analyses were conducted.Results: When reported real-world adherence rates were included only for initial stool-based screening, mt-sDNA was cost-effective versus FIT ($62,814/QALY) and FOBT ($39,171/QALY); mt-sDNA also yielded improved clinical outcomes. When reported real-world adherence rates were included for both initial stool-based screening and follow-up colonoscopy (when A c c e p t e d M a n u s c r i p t indicated), mt-sDNA was increasingly cost-effective compared to FIT and FOBT ($31,725/QALY and $28,465/QALY, respectively), with further improved clinical outcomes.Limitations: Results are based on real-world cross-sectional adherence rates and may vary in the context of other types of settings. Only guideline-recommended stool-based strategies were considered in this analysis. Conclusion:Comparisons of the effectiveness and benefits of specific CRC screening strategies should include both test-specific performance characteristics and real-world adherence to screening tests and, when indicated, follow-up colonoscopy.

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Section: Accepted Manuscript Discussionmentioning

confidence: 97%

Section: Accepted Manuscript Discussionmentioning

confidence: 99%

Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population

Fisher

Karlitz

Jeyakumar³

et al. 2021

Journal of Medical Economics

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“…Interestingly, previous studies evaluating the effect of outreach programs related to stool-based tests mostly included the Medicare population. 5 , 16 , 17 Our study adds to the existing research literature showing the impact of inreach and outreach interventions for the mt-sDNA CRC screening test among a younger commercially insured employer population.…”

Section: Discussionmentioning

confidence: 88%

Evaluating Outreach Methods for Multi-Target Stool DNA Test for Colorectal Cancer Screening Among an Employer Population

Shepherd

Lecorps

Harris-Shapiro³

et al. 2021

J Prim Care Community Health

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Introduction/Objectives: Despite compelling evidence of clinical and economic benefits, adherence to colorectal cancer (CRC) screening remains low. Increasing public awareness through various outreach methods may improve screening uptake. The objective of this study was to evaluate the uptake of non-invasive multi-target stool DNA (mt-sDNA) by different outreach methods in an average-risk employer population. Methods: This retrospective observational study included CRC screening-eligible individuals aged ≥50 years insured by the Metropolitan Nashville Public Schools (MNPS) employee healthcare plan. The study intervention arms included population-based outreach and office visit-based interaction. The mt-sDNA completion rate (proportion of individuals who return the mt-sDNA kit after consenting to have it shipped to their home), proportion of patients who performed follow-up colonoscopy after a positive test, and time to follow-up colonoscopy were assessed. Results: A total of 167 mt-sDNA kits were shipped to eligible participants (aged 50-64 years) in the population-based outreach arm. In the office visit-based interaction arm, a total of 132 mt-sDNA kits were shipped to eligible participants (aged ≥50 years). The mt-sDNA completion rate was significantly higher for office visit-based interaction as compared to population-based outreach (76.8% vs 53.5%; P < .001) among those aged 50 to 64 years. While all patients aged 50 to 64 years with a positive mt-sDNA result received a follow-up colonoscopy in both arms, the median time to follow-up colonoscopy was shorter among the population-based outreach (55 vs 136 days; P < .05). Conclusions: Office visit-based interaction was associated with a higher mt-sDNA completion rate as compared to the population-based outreach among average-risk, CRC screening-eligible individuals aged 50 to 64 years old.

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“…Other adherence rates for the stool-tests have been published that vary by the population evaluated and how adherence was defined. [19][20][21][22][23][24][25][26] Therefore, a range of adherence rates from 30% to 100% were also applied in the model to accommodate the potential variability in real-world adherence. Higher LYG with mt-sDNA was observed compared with the blood-based test (with 10% adenoma sensitivity) at all levels of adherence, even when assuming adherence as low as 30% for mt-sDNA and as high as 100% for the blood-based test.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Simulated Outcomes Between Stool- and Blood-Based Colorectal Cancer Screening Tests

Fendrick

Vahdat

Chen

et al. 2022

Preprint

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Objectives: The Centers for Medicare & Medicaid Services (CMS) recommends covering blood-based tests meeting proposed minimum performance thresholds for colorectal cancer (CRC) screening. Outcomes were compared between currently available stool-based screening tests and a hypothetical blood-based test meeting CMS minimum thresholds. Methods: Using the CRC-AIM model, outcomes were simulated for average-risk individuals screened between ages 45-75 years with triennial multi-target stool DNA (mt-sDNA), annual fecal immunochemical test (FIT), and annual fecal occult blood test (FOBT). Per CMS guidance, blood-based CRC screening was modeled triennially, with 74% CRC sensitivity and 90% specificity. Although not specified by CMS, adenoma sensitivity was set between 10-20%. Published adenoma and CRC sensitivity and specificity were used for stool-based tests. Adherence was set at (a) 100%, (b) 30-70%, in 10% increments, and (c) real-world rates for stool-based tests (mt-sDNA=65.6%; FIT=42.6%; FOBT=34.4%). Results: Assuming perfect adherence, a blood-based test produced ≥19 lower LYG than stool-based strategies. At the best-case scenario for blood-based tests (100% adherence and 20% adenoma sensitivity), mt-sDNA at real-world adherence achieved more LYG (287.2 vs 297.1, respectively) with 14% fewer colonoscopies. At 100% blood-based test adherence and real-world mt-sDNA and FIT adherence, the blood-based test would require advanced adenoma sensitivity of 30% to reach the LYG of mt-sDNA (297.1) and approximately 15% sensitivity to reach the LYG of FIT (258.9). Conclusions: This model suggests that blood-based tests with CMS minimally-acceptable CRC sensitivity and low advanced adenoma sensitivity will frequently yield inferior outcomes to stool-based testing across a wide range of adherence assumptions.

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Effectiveness of a mailed fecal immunochemical test outreach: a Medicare Advantage pilot study

Cited by 15 publications

References 27 publications

Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population

Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population

Evaluating Outreach Methods for Multi-Target Stool DNA Test for Colorectal Cancer Screening Among an Employer Population

Comparison of Simulated Outcomes Between Stool- and Blood-Based Colorectal Cancer Screening Tests

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