Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People
To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. A Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence...
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creator | Redwood, Diana G. Dinh, Tuan A. Kisiel, John B. Borah, Bijan J. Moriarty, James P. Provost, Ellen M. Sacco, Frank D. Tiesinga, James J. Ahlquist, David A. |
description | To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.
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.
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.
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. |
doi_str_mv | 10.1016/j.mayocp.2020.07.035 |
format | Article |
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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.
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.
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.</description><identifier>ISSN: 0025-6196</identifier><identifier>EISSN: 1942-5546</identifier><identifier>DOI: 10.1016/j.mayocp.2020.07.035</identifier><identifier>PMID: 33840520</identifier><language>eng</language><publisher>England: Elsevier Inc</publisher><subject>Adenoma - diagnosis ; Adenoma - economics ; Adenoma - ethnology ; Adenoma - metabolism ; Adult ; Aged ; Alaska - epidemiology ; Alaska Natives ; Biomarkers - analysis ; Biomarkers - metabolism ; Colonoscopy ; Colonoscopy - economics ; Colorectal cancer ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - economics ; Colorectal Neoplasms - ethnology ; Colorectal Neoplasms - metabolism ; Comparative analysis ; Computer Simulation ; Cost-Benefit Analysis ; Diagnosis ; DNA - analysis ; Early Detection of Cancer - economics ; Early Detection of Cancer - methods ; Economic aspects ; Feces - chemistry ; Female ; Genetic screening ; Health aspects ; Humans ; Incidence ; Male ; Markov Chains ; Middle Aged ; Models, Economic ; Native Americans ; Occult Blood ; Patient Compliance - statistics & numerical data ; Quality-Adjusted Life Years</subject><ispartof>Mayo Clinic proceedings, 2021-05, Vol.96 (5), p.1203-1217</ispartof><rights>2020 Mayo Foundation for Medical Education and Research</rights><rights>Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.</rights><rights>COPYRIGHT 2021 Elsevier, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c575t-e97de091a4e5682aaab6ff582174cd093636470278c497cf7420395bc57dedf13</citedby><cites>FETCH-LOGICAL-c575t-e97de091a4e5682aaab6ff582174cd093636470278c497cf7420395bc57dedf13</cites><orcidid>0000-0003-0360-5729</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33840520$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Redwood, Diana G.</creatorcontrib><creatorcontrib>Dinh, Tuan A.</creatorcontrib><creatorcontrib>Kisiel, John B.</creatorcontrib><creatorcontrib>Borah, Bijan J.</creatorcontrib><creatorcontrib>Moriarty, James P.</creatorcontrib><creatorcontrib>Provost, Ellen M.</creatorcontrib><creatorcontrib>Sacco, Frank D.</creatorcontrib><creatorcontrib>Tiesinga, James J.</creatorcontrib><creatorcontrib>Ahlquist, David A.</creatorcontrib><title>Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People</title><title>Mayo Clinic proceedings</title><addtitle>Mayo Clin Proc</addtitle><description>To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.
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.
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.
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.</description><subject>Adenoma - diagnosis</subject><subject>Adenoma - economics</subject><subject>Adenoma - ethnology</subject><subject>Adenoma - metabolism</subject><subject>Adult</subject><subject>Aged</subject><subject>Alaska - epidemiology</subject><subject>Alaska Natives</subject><subject>Biomarkers - analysis</subject><subject>Biomarkers - metabolism</subject><subject>Colonoscopy</subject><subject>Colonoscopy - economics</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - economics</subject><subject>Colorectal Neoplasms - ethnology</subject><subject>Colorectal Neoplasms - metabolism</subject><subject>Comparative analysis</subject><subject>Computer Simulation</subject><subject>Cost-Benefit Analysis</subject><subject>Diagnosis</subject><subject>DNA - analysis</subject><subject>Early Detection of Cancer - economics</subject><subject>Early Detection of Cancer - methods</subject><subject>Economic aspects</subject><subject>Feces - chemistry</subject><subject>Female</subject><subject>Genetic screening</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Markov Chains</subject><subject>Middle Aged</subject><subject>Models, Economic</subject><subject>Native Americans</subject><subject>Occult Blood</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Quality-Adjusted Life Years</subject><issn>0025-6196</issn><issn>1942-5546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksFu1DAQhiMEokvhDRDyCXFJsBM7Xl-QVqGFSqUgtZwtrzPe9eLEi-2s2FfhaXG0LVIPIB8sj7_fM-P5i-I1wRXBpH2_qwZ19Hpf1bjGFeYVbtiTYkEErUvGaPu0WGBcs7Iloj0rXsS4wxhzIejz4qxplhSzGi-K352PqbwwBnSyBxghRuQN-jK5ZJMKG0joNnnv0MebFbqDmOy4QYeIOu_86KP2-yPyAV2CVg5dDcM0er2Fwc7HB9xkYOZDzpHDnRo1BHSrA8A439sRrZyKPxS6UXMR6Bv4vYOXxTOjXIRX9_t58f3y4q77XF5__XTVra5LzThLJQjeAxZEUWDtslZKrVtj2LImnOoei6ZtWspxzZeaCq4NpzVuBFtndQ-9Ic158e707j74n1OuWQ42anBOjeCnKGtGyFII0oiMVid0oxxIOxqfgtJ59XPLfgRjc3zVtpTVOS3PgrePBJlJ8Ctt1BSj_De4BeXSNno3JevH-BikJ1AHH2MAI_fBDiocJcFyNobcyZMx5GwMibnMxsiyN_dNTusB-r-iBydk4MMJgPzVBwtBRm0hT6q389xk7-3_M_wBaLPLXA</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Redwood, Diana G.</creator><creator>Dinh, Tuan A.</creator><creator>Kisiel, John B.</creator><creator>Borah, Bijan J.</creator><creator>Moriarty, James P.</creator><creator>Provost, Ellen M.</creator><creator>Sacco, Frank D.</creator><creator>Tiesinga, James J.</creator><creator>Ahlquist, David A.</creator><general>Elsevier Inc</general><general>Elsevier, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0360-5729</orcidid></search><sort><creationdate>202105</creationdate><title>Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People</title><author>Redwood, Diana G. ; Dinh, Tuan A. ; Kisiel, John B. ; Borah, Bijan J. ; Moriarty, James P. ; Provost, Ellen M. ; Sacco, Frank D. ; Tiesinga, James J. ; Ahlquist, David A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c575t-e97de091a4e5682aaab6ff582174cd093636470278c497cf7420395bc57dedf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adenoma - diagnosis</topic><topic>Adenoma - economics</topic><topic>Adenoma - ethnology</topic><topic>Adenoma - metabolism</topic><topic>Adult</topic><topic>Aged</topic><topic>Alaska - epidemiology</topic><topic>Alaska Natives</topic><topic>Biomarkers - analysis</topic><topic>Biomarkers - metabolism</topic><topic>Colonoscopy</topic><topic>Colonoscopy - economics</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - economics</topic><topic>Colorectal Neoplasms - ethnology</topic><topic>Colorectal Neoplasms - metabolism</topic><topic>Comparative analysis</topic><topic>Computer Simulation</topic><topic>Cost-Benefit Analysis</topic><topic>Diagnosis</topic><topic>DNA - analysis</topic><topic>Early Detection of Cancer - economics</topic><topic>Early Detection of Cancer - methods</topic><topic>Economic aspects</topic><topic>Feces - chemistry</topic><topic>Female</topic><topic>Genetic screening</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Markov Chains</topic><topic>Middle Aged</topic><topic>Models, Economic</topic><topic>Native Americans</topic><topic>Occult Blood</topic><topic>Patient Compliance - statistics & numerical data</topic><topic>Quality-Adjusted Life Years</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Redwood, Diana G.</creatorcontrib><creatorcontrib>Dinh, Tuan A.</creatorcontrib><creatorcontrib>Kisiel, John B.</creatorcontrib><creatorcontrib>Borah, Bijan J.</creatorcontrib><creatorcontrib>Moriarty, James P.</creatorcontrib><creatorcontrib>Provost, Ellen M.</creatorcontrib><creatorcontrib>Sacco, Frank D.</creatorcontrib><creatorcontrib>Tiesinga, James J.</creatorcontrib><creatorcontrib>Ahlquist, David A.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Mayo Clinic proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Redwood, Diana G.</au><au>Dinh, Tuan A.</au><au>Kisiel, John B.</au><au>Borah, Bijan J.</au><au>Moriarty, James P.</au><au>Provost, Ellen M.</au><au>Sacco, Frank D.</au><au>Tiesinga, James J.</au><au>Ahlquist, David A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People</atitle><jtitle>Mayo Clinic proceedings</jtitle><addtitle>Mayo Clin Proc</addtitle><date>2021-05</date><risdate>2021</risdate><volume>96</volume><issue>5</issue><spage>1203</spage><epage>1217</epage><pages>1203-1217</pages><issn>0025-6196</issn><eissn>1942-5546</eissn><abstract>To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.
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.
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.
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.</abstract><cop>England</cop><pub>Elsevier Inc</pub><pmid>33840520</pmid><doi>10.1016/j.mayocp.2020.07.035</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0003-0360-5729</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adenoma - diagnosis Adenoma - economics Adenoma - ethnology Adenoma - metabolism Adult Aged Alaska - epidemiology Alaska Natives Biomarkers - analysis Biomarkers - metabolism Colonoscopy Colonoscopy - economics Colorectal cancer Colorectal Neoplasms - diagnosis Colorectal Neoplasms - economics Colorectal Neoplasms - ethnology Colorectal Neoplasms - metabolism Comparative analysis Computer Simulation Cost-Benefit Analysis Diagnosis DNA - analysis Early Detection of Cancer - economics Early Detection of Cancer - methods Economic aspects Feces - chemistry Female Genetic screening Health aspects Humans Incidence Male Markov Chains Middle Aged Models, Economic Native Americans Occult Blood Patient Compliance - statistics & numerical data Quality-Adjusted Life Years |
title | Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People |
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