Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal...

Area of Science:

• Health Economics
• Preventive Medicine
• Oncology

Background:

• Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes.
• Alaska Native adults face unique healthcare challenges and may benefit from tailored screening strategies.
• Evaluating the cost-effectiveness of different screening modalities is essential for resource allocation.

Purpose of the Study:

• To compare the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) against colonoscopy and fecal immunochemical testing (FIT) for colorectal cancer screening in Alaska Native adults.
• To assess the impact of these screening methods on CRC incidence, mortality, costs, and quality-adjusted life-years (QALYs) over a 40-year period.

Main Methods:

• A Markov model was employed to simulate the long-term effects of three screening strategies: MT-sDNA, colonoscopy, and annual FIT.
• The model incorporated updated evidence on screening test performance, adherence rates, and costs.
• Key outcomes analyzed included CRC incidence, mortality, total costs, QALYs gained, and incremental cost-effectiveness ratios (ICERs).

Main Results:

• All screening strategies reduced CRC incidence and increased QALYs compared to no screening.
• MT-sDNA demonstrated the highest reduction in CRC incidence (66%) and largest QALY gains (0.19 per person) with perfect adherence.
• Colonoscopy was the most expensive strategy. Even with imperfect adherence, MT-sDNA yielded superior QALYs compared to FIT and colonoscopy, with favorable ICERs ranging from $1740 to $75,868 per QALY saved.

Conclusions:

• Multitarget stool DNA testing (MT-sDNA) is a cost-effective colorectal cancer screening option for the Alaska Native population.
• MT-sDNA offers significant advantages in terms of QALY savings and cost-effectiveness compared to colonoscopy and FIT, even under varied adherence scenarios.
• The findings support the implementation of MT-sDNA as a preferred screening strategy in this demographic.