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
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.
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