Characteristics of a cost-effective blood test for colorectal cancer screening

Journal Article · Thu Jun 06 00:00:00 EDT 2024 · JNCI, Journal of the National Cancer Institute

DOI:https://doi.org/10.1093/jnci/djae124· OSTI ID:2566845

Nascimento de Lima, Pedro ^[1]; van den Puttelaar, Rosita ^[2]; Knudsen, Amy B. ^[3]; Hahn, Anne I. ^[4]; Kuntz, Karen M. ^[5]; Ozik, Jonathan ^[6]; Collier, Nicholson ^[6]; Alarid-Escudero, Fernando ^[7]; Zauber, Ann G. ^[4]; Inadomi, John M. ^[8]; Lansdorp-Vogelaar, Iris ^[2]; Rutter, Carolyn M. ^[9]

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1. RAND Corporation, Arlington, VA (United States)
2. Erasmus University, Rotterdam (Netherlands)
3. Massachusetts General Hospital, Boston, MA (United States)
4. Memorial Sloan Kettering Cancer Center, New York, NY (United States). Sloan Kettering Institute
5. Univ. of Minnesota, Minneapolis, MN (United States)
6. Argonne National Laboratory (ANL), Argonne, IL (United States)
7. Stanford Univ., CA (United States)
8. Univ. of Utah, Salt Lake City, UT (United States)
9. Fred Hutchinson Cancer Research Center, Seattle, WA (United States)

Background: Blood-based biomarker tests can potentially change the landscape of colorectal cancer (CRC) screening. We characterize the conditions under which blood test screening would be as effective and cost-effective as annual fecal immunochemical testing or decennial colonoscopy. Methods: We used the 3 Cancer Information and Surveillance Modeling Network–Colon models to compare scenarios of no screening, annual fecal immunochemical testing, decennial colonoscopy, and a blood test meeting Centers for Medicare & Medicaid (CMS) coverage criteria (74% CRC sensitivity and 90% specificity). We varied the sensitivity to detect CRC (74%-92%), advanced adenomas (10%-50%), screening interval (1-3 years), and test cost ($25-$500). Primary outcomes included quality-adjusted life-years (QALY) gained from screening and costs for a US average-risk cohort of individuals aged 45 years. Results: Annual fecal immunochemical testing yielded 125-163 QALY gained per 1000 at a cost of 3811-5384 dollars per person, whereas colonoscopy yielded 132-177 QALY gained at a cost of 5375-7031 dollars per person. A blood test with 92% CRC sensitivity and 50% advanced adenoma sensitivity yielded 117-162 QALY gained if used every 3 years and 133-173 QALY gained if used every year but would not be cost-effective if priced above $$125 per test. If used every 3 years, a $500 blood test only meeting CMS coverage criteria yielded 83-116 QALY gained at a cost of $8559-$9413 per person. Conclusion: Blood tests that only meet CMS coverage requirements should not be recommended to patients who would otherwise undergo screening by colonoscopy or fecal immunochemical testing because of lower benefit. Blood tests need higher advanced adenoma sensitivity (above 40%) and lower costs (below $125) to be cost-effective.

• Research Organization: Argonne National Laboratory (ANL), Argonne, IL (United States)
• Sponsoring Organization: USDOE Office of Science (SC), Basic Energy Sciences (BES); National Institutes of Health (NIH)
• Grant/Contract Number: AC02-06CH11357
• OSTI ID: 2566845
• Journal Information: JNCI, Journal of the National Cancer Institute, Journal Name: JNCI, Journal of the National Cancer Institute Journal Issue: 10 Vol. 116; ISSN 0027-8874
• Publisher: Oxford University Press
• Country of Publication: United States
• Language: English

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60 APPLIED LIFE SCIENCES