Estimated impact and value of blood-based colorectal cancer screening at varied adherence compared with stool-based screening

Figures & data

Figure 1. (a) LYG and LYG per COL (benefit-to-burden ratio) and (b) CRC cases and deaths averted per 1,000 individuals. Results are for triennial mt-sDNA at published real-world adherence (65.6%) and a triennial blood-based test at adherence equal to mt-sDNA real-world adherence, increasing adherence relative to mt-sDNA real-world adherence, or at perfect (100%) adherence. Percentages over each column indicate the percent higher outcome with mt-sDNA relative to the blood-based test. Abbreviations: CRC, colorectal cancer; COL, colonoscopy; LYG, life-years gained; mt-sDNA, multi-target stool DNA.

Figure 2. Percentage of LYG per 1,000 individuals resulting from detection of adenomas or CRC cases. Results are for triennial mt-sDNA at published real-world adherence (65.6%) and a triennial blood-based test at adherence equal to mt-sDNA real-world adherence, increasing adherence relative to mt-sDNA real-world adherence, or at perfect (100%) adherence. Abbreviations: CRC, colorectal cancer; LYG, life-years gained; mt-sDNA, multi-target stool DNA.

Table 1. Estimated health outcomes per 1,000 individuals screened for CRC from age 45–75 years.

Test	Screening Adherence	Follow-up COLs	Surveillance COLs	COLs for Symptoms	Total COLs	LYG	LYG per COL^a	CRC Incidence Cases	CRC Mortality Cases
No screening	–	–	–	80	80	–	–	80	37
mt-sDNA	65.6%	767	778	13	1558	306	0.196	28	10
Blood test	65.6% (0% higher)	725	495	25	1245	218	0.175	50	18
	10% higher	748	511	24	1284	223	0.174	49	18
	20% higher	769	528	23	1320	227	0.172	48	17
	30% higher	787	535	23	1345	231	0.172	48	17
	40% higher	798	542	22	1362	234	0.172	47	17
	100%	824	559	21	1404	236	0.168	46	16

Results are for triennial mt-sDNA at published real-world adherence (65.6%) and a triennial blood-based test at adherence equal to mt-sDNA real-world adherence, increasing adherence relative to mt-sDNA real-world adherence, or at perfect (100%) adherence.

Abbreviations. COL, colonoscopy; CRC, colorectal cancer; LYG, life-years gained; mt-sDNA, multi-target stool DNA.

^a Represents the benefit-to-burden ratio.

Table 2. Estimated economic outcomes (discounted costs and QALYs).

Test	Screening Adherence	Total Costs^a^,b	QALY	Δ Cost	Δ QALY	ICER^c	Expected Total Cost to be Cost-Effective	Non-Screening Cost^d	Incremental Screening Price^e	Expected Times Screening Offered	VBP^f
mt-sDNA	65.6%	$7,165	16.453	REF	REF	–	–	–	–	–	–
Blood test	65.6% (0% higher)	$10,435	16.421	$3,271	−0.0324	−$100,907	$3,923.03	$6,302	−$2,379	4.6	−$515
	10% higher	$10,573	16.422	$3,408	−0.0310	−$109,905	$4,063.49	$6,292	−$2,228	4.8	−$466
	20% higher	$10,688	16.424	$3,523	−0.0298	−$118,070	$4,180.53	$6,281	−$2,101	4.9	−$427
	30% higher	$10,825	16.425	$3,661	−0.0286	−$128,064	$4,306.15	$6,301	−$1,995	5.1	−$395
	40% higher	$10,913	16.426	$3,749	−0.0278	−$134,617	$4,379.76	$6,285	−$1,905	5.2	−$368
	100%	$11,068	16.426	$3,904	−0.0275	−$141,768	$4,411.04	$6,318	−$1,907	5.3	−$359

Results are for triennial mt-sDNA at published real-world adherence (65.6%) and triennial blood-based test at adherence equal to mt-sDNA real-world adherence, increasing adherence relative to mt-sDNA real-world adherence, or at perfect (100%) adherence. WTP threshold is set at $100,000 per QALY.

Abbreviations. COL, colonoscopy; CRC, colorectal cancer; ICER, incremental cost-effectiveness ratio; mt-sDNA, multi-target stool DNA; QALY, quality-adjusted life year; REF, reference; VBP, value-based pricing; WTP, willingness-to-pay.

^a Total costs include initial screening, follow-up colonoscopies and associated complications, and CRC medical costs.

^b 3% annual discount for costs.

^c For all scenarios the ICER is negative, implying that blood-based tests with any adherence are dominated by mt-sDNA.

^d Non-screening costs are equivalent to total costs without the screening costs.

^e Incremental screening price is the difference between the non-screening costs and the expected cost to be cost-effective.

^f At a WTP threshold of $100,000 per QALY.

Data availability statement

CRC-AIM demonstrates the approach by which existing CRC models can be reproduced from publicly available information and provides a ready opportunity for interested researchers to leverage the model for future collaborative projects or further adaptation and testing. To promote transparency and credibility of this new model, CRC-AIM’s formulas and parameters are available in the supplementary documents of an open-access publication²⁷.