Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives

Abstract

Aims: To evaluate total costs and health consequences of a colorectal cancer (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of Integrated Delivery Networks (IDNs) and payers in the United States.

Materials and methods: We developed a budget impact and cost-consequence model that simulates CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and an increased mt-sDNA scenario were modeled. The status quo includes the current screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. Costs for both the IDN and the payer perspectives incorporated diagnostic and surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN perspective included screening program costs, composed of direct nonmedical (e.g. patient navigation) and indirect (e.g. administration) costs. It was assumed that IDNs do not incur the costs for stool-based screening tests or bowel preparation for colonoscopies.

Results: In a population of one million covered lives, the 10-year incremental cost savings incurred by increasing mt-sDNA utilization was $19.6 M for the IDN and $4.4 M for the payer. The incremental savings per-person-per-month were $0.16 and $0.04 for the IDN and payer, respectively. For both perspectives, increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs. Extending screening eligibility to 45- to 75-year-olds slightly decreased the overall cost savings.

Limitations: The natural history of CRC was not simulated; however, many of the utilized parameters were extracted from highly vetted natural history models or published literature. Direct nonmedical and indirect costs for CRC screening programs are applied on a per-person-per modality basis, whereas in reality some of these costs may be fixed.

Conclusions: Increased mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall costs for both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years.

Keywords:

• Colorectal cancer screening
• mt-sDNA
• FIT
• colonoscopy

JEL CLASSIFICATION CODES:

• B23
• B41
• C01
• C51

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Correction

Notes

Transparency

Declaration of funding

The funding source is Exact Sciences Corporation.

Declaration of financial/other relationships

Joanne M Hathway, MPH: is an employee of Precision Health Economics and Outcomes Research, which provides consulting services to the pharma, biotech, and diagnostic industry including Exact Sciences. Precision Health Economics and Outcomes Research has received professional fees for the development of the economic model.

Lesley-Ann Miller-Wilson, PhD, MBA: Employment, Stock from Exact Sciences Corporation.

Ivar S Jensen, MBA: is an employee of Precision Health Economics and Outcomes Research which provides consulting services to the pharma, biotech, and diagnostic industry including Exact Sciences Corporation. Precision Health Economics and Outcomes Research has received professional fees for the development of the economic model.

Burak Ozbay, PhD: Employment, Stock from Exact Sciences Corporation.

Catherine Regan, BA: is an employee of Precision Health Economics and Outcomes Research which provides consulting services to the pharma, biotech, and diagnostic industry including Sciences Corporation. Precision Health Economics and Outcomes Research has received professional fees for the development of the economic model.

Anupam B Jena, MD, PhD: Dr. Jena reports personal fees from Pfizer, personal fees from Hill Rom Services, Inc., personal fees from Bristol Myers Squibb, personal fees from Novartis Pharmaceuticals, personal fees from Vertex Pharmaceuticals, personal fees from Precision Health Economics, personal fees from Amgen, personal fees from Eli Lilly, personal fees from Analysis Group, personal fees from Sanofi Aventis, personal fees from Celgene, personal fees from Tesaro, personal fees from AstraZeneca, personal fees from Biogen, outside the submitted work.

Milton C Weinstein, PhD: Dr. Weinstein reports personal fees from Precision Health Economics and Outcomes Research,, which provides consulting services to the pharma, biotech, and diagnostic industry including Exact Sciences Corporation, during the conduct of the study.

Philip D Parks, MD, MPH: Employment, Stock from Exact Sciences Corporation.

JME peer reviewers on this manuscript have received an honorarium from JME for their review work, but have no other relevant financial relationships to disclose.

Author contributions

All authors were instrumental in drafting the manuscript and participated extensively in review and editing of the manuscript.

Acknowledgements

The authors would like to acknowledge Andrew Piscitello, PhD, Weiyu Yao, MSc, and Phil L Cyr, MPH.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/13696998.2021.1935473)

Notes

1 Mt-sDNA’s compliance rate represents the cumulative completed tests from kits shipped to patients during the 6-month period ending 12 months prior to the end of the Q3 2019, excluding program orders.

2 Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA. 2016 Jun 21;315(23):2595–609, Supplement, Table 6a.

3 Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA. 2016 Jun 21;315(23):2595–609, Supplement, Table 5a.

4 Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA. 2016 Jun 21;315(23):2595–609, Supplement, Table 3a.