D0178 - Comparison of Cost-Effectiveness Outcomes Between a Novel Multitargeted Stool-Based RNA Test and Alternative Non-Invasive Stool and Blood Tests for Colorectal Cancer Screening
Haytham Gareer, MD, PhD, MBA1, Andrew Barnell, MBA1, Vincent Wong, MBA2, Jeffrey M. Salzman, 2, Erica Barnell, PhD1 1Geneoscopy, Inc., St. Louis, MO; 2Geneoscopy, St. Louis, MO
Introduction: Colorectal cancer (CRC) mortality has been significantly mitigated by increased CRC screening via colonoscopy. Colonoscopy has low compliance rates due to invasiveness, procedure-associated risks, bowel preparation, and time requirements. Existing non-invasive screening methods are limited by relatively low sensitivity for precancerous lesions, especially advanced adenomas (AAs). Using a Markov model, cost-effectiveness outcomes were compared between a novel multitargeted stool RNA (mt-sRNA) test, existing stool-based screening tests (fecal immunochemical test [FIT], and multitarget stool DNA [mt-sDNA]), no screening, and a recently introduced triennial blood-based screening test.
Methods: The Markov model compared morbidity, mortality, and cost using 1,000 average-risk patients 45-75 years of age over a 30-year time horizon. The model input included test-specific sensitivity and specificity with a fixed incidence and prevalence of CRCs/AAs to assess lesion detection rates across each screening method. Reimbursement rates were assumed equal for blood, mt-sDNA, and mt-sRNA tests ($508). Data on distribution across disease stages and five-year survival rates predicted long-term outcomes for patients with CRC. The model accounts for the cost of screening, complications associated with colonoscopy, surveillance/follow-up requirements, and the cost of CRC treatment. For the primary analysis, adherence was assumed to be 100%. For secondary research, adherence was set at 40%, 60%, and 80%.
Results: At 100% adherence, the mt-sRNA test resulted in an additional reduction in CRC cases by 68.1% (blood test), 42.5% (mt-sDNA test), 30.8% (FIT test), and 82.1% (no screening). The mt-sRNA screening strategy also resulted in the reduction of deaths by 64.7% (blood test), 39.8% (mt-sDNA test), 29.8% (FIT test), and 78.3% (no screening). When adherence is set at 40%, 60%, or 80%, use of the mt-sRNA test results in an increased number of pre-cancerous adenomas detected relative to all other screening strategies. Incremental costs associated with the mt-sRNA test were intermediary with higher costs associated with follow-on colonoscopy/surveillance, and lower costs associated with CRC treatment.
Discussion: This model suggests that CRC screening tests that target advanced adenomas detection have superior cost-effectiveness due to better cancer prevention. The mt-sRNA test is a more cost-effective alternative for colorectal cancer screening in the average-risk population than other non-invasive strategies.
Adherence rate
mt-sRNA test vs.
Incremental
CRC cases prevented
CRC cases reduction (%)
CRC deaths reduction (%)
Incremental costs per CRC case prevented
Incremental costs per CRC case prevented
40% for all tests
Blood test
14
39.5%
35.1%
-$175,379
-$311,289
mt-sDNA
6
22.7%
19.9%
-$168,747
-$302,667
FIT
6
21.2%
19.0%
$8,666
$14,681
No screening
20
48.1%
42.8%
$67,232
$122,252
60% for all tests
Blood test
16
51.5%
47.0%
-$182,381
-$309,202
mt-sDNA
7
30.8%
27.7%
-$178,940
-$293,907
FIT
5
23.0%
21.2%
$188,435
$296,188
No screening
27
63.6%
58.3%
$29,789
$52,683
80% for all tests
Blood test
17
60.3%
56.2%
-$188,028
-$306,278
mt-sDNA
7
37.2%
34.2%
-$182,141
-$284,899
FIT
4
26.1%
24.6%
$409,606
$607,669
No screening
31
73.9%
69.2%
$19,817
$34,312
100% for all tests
Blood test
16
68.1%
64.7%
-$3,104,328
-$103,478
mt-sDNA
6
42.5%
39.8%
-$1,073,985
-$35,799
FIT
3
30.8%
29.8%
$2,289,314
$76,310
No screening
35
82.1%
78.3%
$612,243
$20,408
Table: Cost-effectiveness of mt-sRNA against other screening modalities at variable adherence rates, per 1000 patients over a 30-year time horizon.
Haytham Gareer, MD, PhD, MBA1, Andrew Barnell, MBA1, Vincent Wong, MBA2, Jeffrey M. Salzman, 2, Erica Barnell, PhD1. D0178 - Comparison of Cost-Effectiveness Outcomes Between a Novel Multitargeted Stool-Based RNA Test and Alternative Non-Invasive Stool and Blood Tests for Colorectal Cancer Screening, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
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