Projected Impact and Cost-Effectiveness of Novel Molecular Blood-Based or Stool-Based Screening Tests for Colorectal...

Area of Science:

• Oncology
• Public Health
• Health Economics

Background:

• Colorectal cancer (CRC) screening is crucial for early detection and improved outcomes.
• Emerging technologies like cell-free DNA blood tests (cf-bDNA) and advanced stool tests offer new avenues for CRC screening.
• The clinical and economic impacts of these novel screening modalities require thorough evaluation.

Purpose of the Study:

• To estimate the clinical and economic impacts of novel colorectal cancer (CRC) screening tests.
• To compare the cost-effectiveness of cf-bDNA and next-generation stool tests against established CRC screening methods.
• To assess the influence of participation rates and test substitution on CRC incidence and mortality.

Main Methods:

• Cost-effectiveness analysis was performed using the MOSAIC (Model of Screening and Surveillance for Colorectal Cancer) simulation model.
• Published data on screening test performance, participation, and costs were utilized.
• The study modeled average-risk individuals aged 45 to 100 years within a health sector perspective.

Main Results:

• Established screening methods like colonoscopy and annual fecal immunochemical tests (FIT) were found to be more cost-effective than novel cf-bDNA tests.
• The cf-bDNA test (Guardant Shield) had a higher cost per quality-adjusted life-year (QALY) gained compared to less expensive and more effective alternatives.
• Sensitivity analyses indicated that incremental costs of novel tests could exceed benefits if screening intervals were shortened, and outcomes depended heavily on patient uptake and substitution patterns.

Conclusions:

• First-generation cf-bDNA tests may offer net benefit or harm, contingent on their ability to engage individuals who decline other screening methods versus replacing more effective existing options.
• The optimal implementation strategy for cf-bDNA tests requires careful consideration of participation dynamics to maximize benefits and minimize potential harms.
• Further research into longitudinal test-specific participation patterns is needed to refine cost-effectiveness models for novel CRC screening technologies.