Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Hathway, J.; Miller‐Wilson, Lesley‐Ann; Jensen, I.; Ozbay, Burak A; Regan, Catherine; Jena, Anupam B.; Weinstein, Milton C.; Parks, Philip D.

doi:10.1080/13696998.2020.1730123

Cited by 12 publications

(22 citation statements)

References 44 publications

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“…A Markov state-transition model was developed to examine the health economic impact of increasing mt-sDNA utilization relative to colonoscopy and FIT 22 . The model assessed the health and economic consequences pertinent to IDNs and payers over a 10-year time horizon, which aligns with the longest recommended screening interval of the modalities being evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…Each time an individual screens, the IDN and payer incur costs. Never-screeners do not enter the screening pool, so they do not incur screening-related costs; however, some never-screeners are diagnosed with CRC due to symptomatic disease, and, therefore, treatment costs are incurred 22 .…”

Section: Imperfect Cross-sectional Adherence Scenariosmentioning

confidence: 99%

“…5 In order to adjust for imperfect adherence, we weighted the reductions according to crosssectional adherence and applied the calculated values per modality to potential screeners. Additional details about this methodology have previously been described 22 .…”

Section: Imperfect Cross-sectional Adherence Scenariosmentioning

confidence: 99%

“…Our previous health economic modeling study used imperfect cross-sectional adherence estimates from the literature [22][23][24][25][26] . That analysis demonstrated cost-savings for ages 50-75 and 45-75 from the integrated delivery network (IDN) and payer perspectives.…”

Section: Introductionmentioning

confidence: 99%

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The health economic impact of varying levels of adherence to colorectal screening on providers and payers

Hathway¹,

Miller‐Wilson

Yao³

et al. 2021

Journal of Medical Economics

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Aims: To examine the impact of increasing multi-target stool DNA test (mt-sDNA [Cologuard]) utilization for colorectal cancer (CRC) screening in cohorts aged 50-75 and 45-75 years old with varying levels of adherence from the perspectives of integrated delivery networks (IDNs) and payers. Materials and methods: We developed a budget impact model that simulates CRC screening with colonoscopy over a 10-year time horizon, fecal immunochemical test (FIT), and mt-sDNA according to the United States Preventive Services Task Force and American Cancer Society guidelines for average risk adults. We evaluated varying levels of screening adherence for a status quo scenario and for an increased mt-sDNA utilization scenario, from the IDN and payer perspectives. The IDN perspective included CRC screening program costs, whereas the payer perspective did not. Conversely, stool-based screening test and bowel preparation costs were unique to the payer perspective. Results: The increased mt-sDNA scenarios yielded cost savings relative to the status quo under all adherence scenarios due to a decrease in screening and surveillance colonoscopies.

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Section: Methodsmentioning

confidence: 99%

Section: Imperfect Cross-sectional Adherence Scenariosmentioning

confidence: 99%

Section: Imperfect Cross-sectional Adherence Scenariosmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The health economic impact of varying levels of adherence to colorectal screening on providers and payers

Hathway¹,

Miller‐Wilson

Yao³

et al. 2021

Journal of Medical Economics

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“…However, it is generally accepted that the total cost of any CRC screening test (eg, FIT, mt-sDNA) should include direct nonmedical costs, and indirect administrative, programmatic, and navigation costs. 18 , 19 …”

Section: Overview/backgroundmentioning

confidence: 99%

Preventing Colorectal Cancer: Pathway to Achieving an 80% Screening Goal in the United States: Overview and Proceedings of a Population Health Advisory Board

Nash

Fabius²,

Skoufalos

2021

Population Health Management

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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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Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Cited by 12 publications

References 44 publications

The health economic impact of varying levels of adherence to colorectal screening on providers and payers

The health economic impact of varying levels of adherence to colorectal screening on providers and payers

Preventing Colorectal Cancer: Pathway to Achieving an 80% Screening Goal in the United States: Overview and Proceedings of a Population Health Advisory Board

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

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