ASPO Abstracts
Health and economic implications for integrated delivery networks of increasing mt-sDNA utilization among colorectal cancer screeners
Category: Early Detection & Risk Prediction
Conference Year: 2020
Abstract Body:
Purpose: The U.S. Preventive Services Task Force recommends screening individuals 50-75 years of
age, at average risk for colorectal cancer (CRC). However, recent Surveillance, Epidemiology, and End
Results (SEER) Program evidence suggests that CRC incidence and mortality are increasing among
people younger than age 50, and the American Cancer Society recommends that CRC screening
begin at age 45 for those at average risk. A decision analytic model based on clinical guidelines and
real-world CRC screening compliance was developed to estimate the health economic impact of
increasing multi-target stool DNA (mt-sDNA) utilization among colonoscopy, fecal immunochemical test
(FIT), and mt-sDNA screeners in integrated delivery networks (IDNs) among individuals ages 50-75
and ages 45-75.
Methods: IDNs were assumed to incur screening program, sedation, colonoscopy, adverse event (AE),
and cancer treatment costs, but no bowel preparation or stool-based screening test costs. Cross-
sectional compliance was 64.0%, 64.7%, and 67.5 for colonoscopy, FIT, and mt-sDNA. Mt-sDNA
utilization was increased from 6% to 28% over the course of 10 years. Demographics, test
performance characteristics, and other clinical parameters were derived from the literature and current
screening guidelines. Screening, adverse event (AE), cancer treatment, surveillance, and
programmatic costs were based on Medicare, the Healthcare Cost and Utilization Project, and
literature. All costs were based on or updated to 2019 USD.
Results: Among a hypothetical cohort of 1M covered lives, greater mt-sDNA utilization yielded
increases in diagnostic colonoscopies (2K) and detected CRC cases (23), and decreases in
surveillance colonoscopies (400) as well as non-neoplastic findings (1.7K). The overall cost savings for
ages 50-75 was $16.2M, corresponding to an incremental savings of $0.14 per person per month
(PPPM), and the overall cost savings for ages 45-75 was $16M, corresponding to an incremental
savings of $0.13 PPPM.
Conclusion: Model results suggest that increased mt-sDNA use may lead to more detected cancers,
reduction in spending, and overall cost of care savings for IDNs among individuals ages 50-75. These
model results hold true when screening eligibility is extended to ages 45-75.
Keywords: Colorectal cancer screening, integrated delivery networks, cost of care, budget impact