Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population

Figures & data

Table 1. Reported test-specific adherence rates.

	mt-sDNA	FIT	FOBT	Follow-up colonoscopy
Scenario 1: 100% adherence for initial stool-based screening and follow-up colonoscopy	100%	100%	100%	100%
Scenario 2: Reported real-world adherence rates used for stool-based screening; 100% adherence for follow-up colonoscopies	71.1%^28	42.6%^29	33.4%^29	100%
Scenario 3: Reported real-world adherence rates used for both stool-based screening and follow-up colonoscopy	71.1%^28	42.6%^29	33.4%^29	mt-sDNA: 73.0%^18 FIT: 47.0%^18 FOBT: 47.0%^a

Abbreviations. FIT, Fecal immunochemical test; FOBT, Fecal occult blood test; mt-sDNA, Multitarget stool DNA test.

^aAssumed to be same as FIT.

Table 2. Discounted clinical outcomes per 1,000 patients.

Scenario	Screening strategy	Number of screening tests	Total number of COLsa	Number of complications	Number of CRC cases	Number of CRC deaths	LYG	Incidence reduction	Mortality reduction
Scenario 1	No screening	0	80	2.4	79.8	36.0	0.00	0%	0%
	mt-sDNA	2,676	1,027	8.5	47.3	18.0	166.5	40.7%	49.9%
	FIT	6,704	1,079	9.4	44.5	16.5	180.0	44.3%	54.0%
	FOBT	5,864	1,248	10.0	42.9	16.0	182.4	46.3%	55.5%
Scenario 2	No screening	0	80	2.2	79.8	36.0	0.00	0%	0%
	mt-sDNA	2,396	850	7.8	50.0	19.5	153.0	37.4%	45.9%
	FIT	3,296	584	6.0	58.0	23.1	120.6	27.3%	35.9%
	FOBT	2,544	580	5.8	60.4	24.6	105.3	24.4%	31.8%
Scenario 3	No screening	0	80	2.2	79.8	36.0	0.00	0%	0%
	mt-sDNA	2,388	632	5.9	58.3	23.9	112.9	27.0%	33.5%
	FIT	3,300	309	4.2	70.0	30.1	56.6	12.4%	16.4%
	FOBT	2,528	310	3.8	70.7	30.7	50.4	11.4%	14.8%

Abbreviations. COL, Colonoscopy; CRC, Colorectal cancer; FIT, Fecal immunochemical test; FOBT, Fecal occult blood test; LYG, Life years gained; mt-sDNA, Multi-target stool DNA.

^aTotal COLs include surveillance colonoscopies, colonoscopies for symptoms. and follow-up colonoscopies.

Table 3. Discounted total costs and QALYs with associated incremental cost-effectiveness ratios.

Scenario	Screening strategy	Discounted costs				Discounted utilities
		Screening	Complications	CRC	Lifetime costsa	Screening disutility	Complications disutility	CRC disutility	QALY
Scenario 1	No screening	$76	$29	$5,911	$6,017	–0.0003	–0.0001	–0.0516	9.3253
	mt-sDNA	$2,303	$119	$4,073	$6,495	–0.0044	–0.0003	–0.0438	9.3906
	FIT	$1,260	$131	$3,902	$5,293	–0.0046	–0.0003	–0.0433	9.3959
	FOBT	$1,352	$140	$3,818	$5,311	–0.0054	–0.0004	–0.0423	9.3967
Scenario 2	No screening	$76	$33	$5,909	$6,019	–0.0003	–0.0001	–0.0516	9.3253
	mt-sDNA	$1,990	$108	$4,227	$6,325	–0.004	–0.0004	–0.0445	9.3853
	FIT	$671	$84	$4,689	$5,443	–0.0025	–0.0002	–0.0477	9.3713
	FOBT	$620	$81	$4,828	$5,529	–0.0025	–0.0002	–0.0480	9.3650
Scenario 3	No screening	$76	$26	$5,911	$6,013	–0.0003	–0.0001	–0.0516	9.3253
	mt-sDNA	$1,754	$82	$4,689	$6,525	–0.0027	–0.0002	–0.0465	9.3694
	FIT	$383	$49	$5,355	$5,797	–0.0013	–0.0001	–0.0499	9.3465
	FOBT	$334	$53	$5,414	$5,801	–0.0013	–0.0001	–0.0499	9.3439

Abbreviations. CRC, Colorectal cancer; FIT, Fecal immunochemical test; FOBT, Fecal occult blood test; mt-sDNA, Multi-target stool DNA; QALY, Quality-adjusted life-years.

^aLifetime costs include screening costs (stool-based screening costs and follow-up/symptom/surveillance colonoscopies, as relevant), cost of complications and cost of CRC).

Figure 1. Incremental cost-effectiveness of mt-sDNA vs. FIT (A) or FOBT (B).

Table 4. ICER for capped adherence sensitivity analyses.

Capped adherence	Δ Cost ($)	Δ QALY	ICER (cost/QALY)
mt-sDNA vs. FIT
Scenario 2: Reported real-world adherence rates used for stool-based screening; 100% adherence assumed for follow-up colonoscopies	$503	0.02730	$18,433
Scenario 3: Reported real-world adherence rates used for both stool-based screening and follow-up colonoscopy	$500	0.02523	$19,812
mt-sDNA vs. FOBT
Scenario 2: Reported real-world adherence rates used for stool-based screening; 100% adherence assumed for follow-up colonoscopies	$409	0.03314	$12,348
Scenario 3: Reported real-world adherence rates used for both stool-based screening and follow-up colonoscopy	$471	0.02822	$16,691

Abbreviations. FIT, Fecal immunochemical test; FOBT, Fecal occult blood test; ICER, Incremental cost-effectiveness ratio; QALY, quality-adjusted life-years.

Figure 2. One-way sensitivity analysis of incremental cost-effectiveness of mt-sDNA vs. (A) FIT or (B) FOBT (scenario 3).

Figure 3. Heatmap of mt-sDNA vs. FIT (A) and mt-sDNA vs. FOBT (B) when varying screening test adherence (follow-up colonoscopy adherence fixed at 100%).

Figure 4. Heatmap of mt-sDNA vs. FIT (A) and mt-sDNA vs. FOBT (B) when varying follow-up colonoscopy adherence (screening test rates fixed).

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