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