| Autor: |
Karlitz JJ; Division of Gastroenterology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado, USA., Fendrick AM; Division of General Medicine and Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, Michigan, USA., Bhatt J; Chicago School of Public Health, University of Illinois, Chicago, Illinois, USA., Coronado GD; Kaiser Permanente Center for Health Research, Portland, Oregon, USA., Jeyakumar S; Maple Health Group, LLC, New York, New York, USA., Smith NJ; Maple Health Group, LLC, New York, New York, USA., Plescia M; Associate of State and Territorial Health Officials, Atlanta, Georgia, USA., Brooks D; Exact Sciences, Madison, Wisconsin, USA., Limburg P; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA., Lieberman D; Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA. |
| Abstrakt: |
Outreach, including patient navigation, has been shown to increase the uptake of colorectal cancer (CRC) screening in underserved populations. This analysis evaluates the cost-effectiveness of triennial multi-target stool DNA (mt-sDNA) versus outreach, with or without a mailed annual fecal immunochemical test (FIT), in a Medicaid population. A microsimulation model estimated the incremental cost-effectiveness ratio using quality-adjusted life years (QALY), direct costs, and clinical outcomes in a cohort of Medicaid beneficiaries aged 50-64 years, over a lifetime time horizon. The base case model explored scenarios of either 100% adherence or real-world reported adherence (51.3% for mt-sDNA, 21.1% for outreach with FIT and 12.3% for outreach without FIT) with or without real-world adherence for follow-up colonoscopy (66.7% for all). Costs and outcomes were discounted at 3.0%. At 100% adherence to both screening tests and follow-up colonoscopy, mt-sDNA costed more and was less effective compared with outreach with or without FIT. When real-world adherence rates were considered for screening strategies (with 100% adherence for follow-up colonoscopy), mt-sDNA resulted in the greatest reduction in incidence and mortality from CRC (41.5% and 45.8%, respectively) compared with outreach with or without FIT; mt-sDNA also was cost-effective versus outreach with and without FIT ($32,150/QALY and $22,707/QALY, respectively). mt-sDNA remained cost-effective versus FIT, with or without outreach, under real-world adherence rates for follow-up colonoscopy. Outreach or navigation interventions, with associated real-world adherence rates to screening tests, should be considered when evaluating the cost-effectiveness of CRC screening strategies in underserved populations. |
