A0179 - Lifetime Impact of the Change in Modality as a Result of Eliminating Cost-Sharing for Follow-Up Colonoscopy After a Positive Stool Test for Colorectal Cancer Screening

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

A. Burak Ozbay, PhD

Exact Sciences Corporation
Madison, WI

A. Mark Fendrick, MD¹, Jing Voon Chen, PhD², A. Burak Ozbay, PhD², Vahab Vahdat, PhD², Paul J. Limburg, MD³
¹University of Michigan, Ann Arbor, MI; ²Exact Sciences Corporation, Madison, WI; ³Mayo Clinic, Rochester, MN

Introduction: Most commercial insurance plans in the US will be required to cover a follow-up colonoscopy after a positive stool test with no patient cost-sharing as of January 1, 2023. In Oregon, a policy that eliminated patient cost-sharing significantly increased the overall uptake of CRC screening and shifted screening modalities from colonoscopy to non-invasive methods. We estimated the clinical and economic effects of these outcomes that may stem from the policy on a cohort of US average-risk individuals newly eligible for CRC screening.

Methods: CRC-AIM, a validated microsimulation model for CRC, was used to simulate 2 million individuals undergoing CRC screening (colonoscopy every 10 years, annual fecal immunochemical test [FIT], triennial multi-target stool DNA [mt-sDNA]) from ages 45-75. Individuals who completed initial CRC screening were assumed to also complete follow-up colonoscopies. Outcomes were aggregated according to the current proportional distribution of different modalities. The baseline scenario represented the utilization of CRC screening prior to implementation of state-level policy (46% colonoscopy, 23% stool test, and 31% unscreened; derived from published literature). Scenarios 1-5 assumed 10% shift from colonoscopy to stool-test utilization with 1, 2, 5, 10, and 15% absolute increase in overall screening rate, respectively.

Results: When 10% shift from screening colonoscopy to stool-test utilization was modeled, an increase in overall screening as low as 1%, compared to the baseline led to lower total costs, and cost per patient screened and higher quality adjusted life years (QALYs) (Table 1). LYG increased by at least 5% while ≥1,200 cases and ≥900 deaths were averted per 1 million individuals with a modest (5%) uptake in total screening. Total colonoscopies were 1.7% lower than the baseline at 15% increase to total screening. All scenarios that included the alternate screening modality distributions were less costly and more effective compared to the baseline, regardless of percent changes to total screening uptake (Figure 1).

Discussion: Based on this modeling analysis, policies that remove cost barriers to completing CRC screening can lead to shifts in test utilization patterns, increase overall participation rates, and improve both economic and clinical outcomes.

Figure: Incremental cost-effectiveness ratio by absolute percent increase in total CRC screening rate. Screening rates were assumed to increase as a consequence of waiving patient cost-sharing leading to a shift from screening colonoscopy to non-invasive methods. Negative ICER indicates that the scenario is less costly and more effective than the baseline. (CRC: colorectal cancer; ICER: incremental cost-effectiveness ratio; QALY: quality-adjusted life year)

Scenario	% COLs	% Stool Tests	% Screened	LYG	CRC Cases	CRC Deaths	Total COLs	Stool Tests	Total Costs	Total QALYs	ICER
Baseline	46	23	69	246.4	36.9	15.6	2298.0	3442.1	$6,901	16.8482	NA
1) 10% shift from COL to stool-test and 1% increase in screening	36	34	70	245.2	37.8	15.8	2051.6	5080.8	$6,628	16.8483	Less costly and more effective
2) 10% shift from COL to stool-test and 2% increase in screening	36	35	71	248.5	37.3	15.5	2066.4	5229.8	$6,629	16.8492	Less costly and more effective
3) 10% shift from COL to stool-test and 5% increase in screening	36	38	74	258.3	35.7	14.7	2110.8	5676.7	$6,632	16.8520	Less costly and more effective
4) 10% shift from COL to stool-test and 10% increase in screening	36	43	79	274.7	33.0	13.3	2184.8	6421.6	$6,638	16.8565	Less costly and more effective
5) 10% shift from COL to stool-test and 15% increase in screening	36	48	84	291.1	30.3	12.0	2258.8	7166.5	$6,644	16.8611	Less costly and more effective

Table: Estimated Outcomes in Baseline Scenario and Scenarios 1-5 Assuming 10% Absolute Reduction in Colonoscopy Utilization and Increased Overall Screening Rate. LYG, CRC cases, CRC deaths, total colonoscopies, and stool tests were calculated per 1000 individuals. Total costs and total QALYS were calculated per person. (COL: colonoscopy; CRC: colorectal cancer; ICER: incremental cost-effectiveness ratio; LYG: life-years gained; NA: not applicable; QALY: quality-adjusted life year)

Disclosures:

A. Mark Fendrick: AbbVie – Consultant. Amgen – Consultant. Arnold Ventures – Grant/Research Support. Centivo – Consultant. Community Oncology Association – Consultant. Covered California – Consultant. EmblemHealth – Consultant. Exact Sciences Corporation – Consultant. Freedman Health – Consultant. Gary and Mary West Health Policy Center – Grant/Research Support. GRAIL – Consultant. Harvard University – Consultant. Health & Wellness Innovations – Consultant. Health at Scale Technologies – Consultant. MedZed – Consultant. National Pharmaceutical Council – Grant/Research Support. Patient-Centered Outcomes Research Institute – Grant/Research Support. Penguin Pay – Consultant. Pharmaceutical Research and Manufacturers of America – Grant/Research Support. Risalto – Consultant. Sempre Health – Consultant. The Agency for Healthcare Research and Quality – Grant/Research Support. The Centers for Medicare and Medicaid Services – Grant/Research Support. The Robert Wood Johnson Foundation – Grant/Research Support. The State of Michigan – Grant/Research Support. The State of Minnesota – Consultant. U.S. Department of Defense – Consultant. Virginia Center for Health Innovation – Consultant. Wellth – Consultant. Zansors – Consultant.

Jing Voon Chen: Exact Sciences Corporation – Employee, Stock-publicly held company(excluding mutual/index funds).

A. Burak Ozbay: Exact Sciences Corporation – Employee, Stock-publicly held company(excluding mutual/index funds).

Vahab Vahdat: Exact Sciences Corporation – Employee, Stock-publicly held company(excluding mutual/index funds).

Paul Limburg: Exact Sciences Corporation – PL serves as Chief Medical Officer for Screening at Exact Sciences through a contracted services agreement with the Mayo Clinic, Royalties.

A. Mark Fendrick, MD¹, Jing Voon Chen, PhD², A. Burak Ozbay, PhD², Vahab Vahdat, PhD², Paul J. Limburg, MD³. A0179 - Lifetime Impact of the Change in Modality as a Result of Eliminating Cost-Sharing for Follow-Up Colonoscopy After a Positive Stool Test for Colorectal Cancer Screening, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.