Economic consequences of increasing mt-sDNA utilization among colorectal cancer screening strategies from a payer perspective

Authors: Hathway JM, Miller-Wilson LA, Jensen IS, Ozbay B, Regan C, Yao W, Jena AB, Weinstein MC, Parks PD

Category: Early Detection & Risk Prediction
Conference Year: 2020

Abstract Body:
Purpose: The American Cancer Society recommends screening individuals ages 45-75 at average risk for colorectal cancer (CRC). When determining coverage for their members, it is important that payers evaluate the potential health outcomes and budget impact of extending CRC screening eligibility to include ages 45-49. A 10-year decision analytic model based on current CRC screening guidelines was simulated to evaluate the health and economic consequences of increasing multi-target stool DNA (mt-sDNA) utilization by 22% among screening strategies from the payer perspective among individuals ages 50-75 and 45-75. Methods: The model included Medicare, Medicaid, and Commercial payer perspectives. It was assumed that all individuals reaching age 65 incurred Medicare costs. Test performance characteristics, clinical treatment and surveillance decisions, and adverse events were derived from the literature. Modality- specific CRC incidences were derived from the Cancer Intervention and Surveillance Modeling Network Screening SimCRC model. Procedure, adverse event (AE), cancer treatment, surveillance, and screening program costs were based on Medicare National Limitation amounts, the Healthcare Cost and Utilization Project, and literature. A Medicare to Commercial cost index (1.27) was applied to costs from published Medicare data to determine Commercial costs. A Medicare to Medicaid cost index (0.72) was applied to Medicare costs to determine Medicaid costs. All costs were based on 2019 USD. Results: Among a hypothetical cohort of 1M covered lives ages 45-75, with all payer types included, greater mt-sDNA utilization yielded increases in diagnostic colonoscopies (2.1K), detected CRC cases (23), and decreases in surveillance colonoscopies (400) and screening colonoscopies (12.8K). The overall cost savings for ages 50-75 was $3.3M, corresponding to incremental savings of $0.03 per member per month (PMPM). For ages 45-75, the cost savings was $3.1M, corresponding to $0.03 PMPM. Conclusion: Increased mt-sDNA use may lead to overall cost savings for payers, when extending screening eligibility to individuals ages 45-75. Increases in diagnostic colonoscopy costs were offset by reductions in screening and surveillance colonoscopies in addition to a reduction in adverse events.

Keywords: Colorectal cancer screening, cost of care, budget impact, payer