Cost-effectiveness of a multicancer early detection test in the US

Area of Science:

• Oncology
• Health Economics
• Biostatistics

Background:

• Multicancer early detection (MCED) testing aims to diagnose cancers earlier, potentially improving patient survival and reducing healthcare expenditures.
• Evaluating the cost-effectiveness of MCED testing is crucial for its clinical implementation, especially considering factors like clinical uncertainty and population heterogeneity.
• A broad coverage MCED test for solid tumors could significantly impact cancer care pathways.

Purpose of the Study:

• To evaluate the cost-effectiveness of multicancer early detection (MCED) testing combined with usual care (UC) screening compared to UC alone.
• To analyze the impact of clinical uncertainties and population heterogeneity on the cost-effectiveness of MCED testing.
• To assess the economic value of MCED testing from a US payer perspective over a lifetime horizon.

Main Methods:

• A hybrid cohort-level model was utilized to compare annual MCED testing plus UC versus UC alone in a US adult population (aged 50-79).
• The model incorporated a lifetime horizon and a US payer perspective.
• Sensitivity and scenario analyses were performed to address clinical uncertainties, including differential survival, cancer progression rates, and implementation strategies.

Main Results:

• MCED testing plus UC identified 7200 additional cancers at earlier stages per 100,000 individuals compared to UC alone.
• This approach resulted in an average gain of 0.14 quality-adjusted life-years (QALYs) and treatment cost savings of $5241 per person.
• The incremental cost-effectiveness ratio (ICER) was $66,048 per QALY gained at a test price of $949, with probabilistic sensitivity analyses indicating cost-effectiveness under various scenarios.

Conclusions:

• Multicancer early detection (MCED) testing, when combined with usual care, is estimated to be cost-effective under a range of plausible clinical scenarios.
• MCED testing demonstrates the potential to improve cancer survival rates.
• The implementation of MCED testing is associated with reductions in overall cancer treatment costs.