Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People
| Autor: | James P. Moriarty, Bijan J. Borah, Tuan A. Dinh, Frank Sacco, Ellen Provost, Diana Redwood, James Tiesinga, John B. Kisiel, David A. Ahlquist |
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| Rok vydání: | 2021 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty Cost effectiveness Colorectal cancer Cost-Benefit Analysis Colonoscopy Feces Internal medicine medicine Surveillance Epidemiology and End Results Humans Computer Simulation Early Detection of Cancer health care economics and organizations Aged medicine.diagnostic_test business.industry Incidence Incidence (epidemiology) DNA General Medicine Middle Aged Alaskan Natives medicine.disease Markov Chains Quality-adjusted life year Models Economic Occult Blood Patient Compliance Female Quality-Adjusted Life Years Colorectal Neoplasms business Incremental cost-effectiveness ratio Alaska Biomarkers |
| Zdroj: | Mayo Clinic Proceedings. 96:1203-1217 |
| ISSN: | 0025-6196 |
| Popis: | Objective To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. Patients and Methods A Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019. Results With perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy. Conclusion Each strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios. |
| Databáze: | OpenAIRE |
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