PMID- 32063100
OWN - NLM
STAT- MEDLINE
DCOM- 20210402
LR  - 20210615
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 23
IP  - 6
DP  - 2020 Jun
TI  - Projecting total costs and health consequences of increasing mt-sDNA utilization 
      for colorectal cancer screening from the payer and integrated delivery network 
      perspectives.
PG  - 581-592
LID - 10.1080/13696998.2020.1730123 [doi]
AB  - Aims: To evaluate total costs and health consequences of a colorectal cancer 
      (CRC) screening program with colonoscopy, fecal immunochemical tests (FIT), and 
      expanded use of multitarget stool DNA (mt-sDNA) from the perspectives of 
      Integrated Delivery Networks (IDNs) and payers in the United States.Materials and 
      methods: We developed a budget impact and cost-consequence model that simulates 
      CRC screening for eligible 50- to 75-year-old adults. A status quo scenario and 
      an increased mt-sDNA scenario were modeled. The status quo includes the current 
      screening mix of colonoscopy (83%), FIT (11%), and mt-sDNA (6%) modalities. The 
      increased mt-sDNA scenario increases mt-sDNA utilization to 28% over 10 years. 
      Costs for both the IDN and the payer perspectives incorporated diagnostic and 
      surveillance colonoscopies, adverse events (AEs), and CRC treatment. The IDN 
      perspective included screening program costs, composed of direct nonmedical (e.g. 
      patient navigation) and indirect (e.g. administration) costs. It was assumed that 
      IDNs do not incur the costs for stool-based screening tests or bowel preparation 
      for colonoscopies.Results: In a population of one million covered lives, the 
      10-year incremental cost savings incurred by increasing mt-sDNA utilization was 
      $16.2 M for the IDN and $3.3 M for the payer. The incremental savings 
      per-person-per-month were $0.14 and $0.03 for the IDN and payer, respectively. 
      For both perspectives, increased diagnostic colonoscopy costs were offset by 
      reductions in screening colonoscopies, surveillance colonoscopies, and AEs. 
      Extending screening eligibility to 45- to 75-year-olds slightly decreased the 
      overall cost savings.Limitations: The natural history of CRC was not simulated; 
      however, many of the utilized parameters were extracted from highly vetted 
      natural history models or published literature. Direct nonmedical and indirect 
      costs for CRC screening programs are applied on a per-person-per modality basis, 
      whereas in reality some of these costs may be fixed.Conclusions: Increased 
      mt-sDNA utilization leads to fewer colonoscopies, less AEs, and lower overall 
      costs for both IDNs and payers, reducing overall screening program costs and 
      increasing the number of cancers detected while maintaining screening adherence 
      rates over 10 years.
FAU - Hathway, Joanne M
AU  - Hathway JM
AD  - Precision Health Economics and Outcomes Research, Boston, MA, USA.
FAU - Miller-Wilson, Lesley-Ann
AU  - Miller-Wilson LA
AD  - Exact Sciences Corporation, Madison, WI, USA.
FAU - Jensen, Ivar S
AU  - Jensen IS
AD  - Precision Health Economics and Outcomes Research, Boston, MA, USA.
FAU - Ozbay, Burak
AU  - Ozbay B
AD  - Exact Sciences Corporation, Madison, WI, USA.
FAU - Regan, Catherine
AU  - Regan C
AD  - Precision Health Economics and Outcomes Research, Boston, MA, USA.
FAU - Jena, Anupam B
AU  - Jena AB
AD  - Harvard T. H. Chan School of Public Health, Boston, MA, USA.
FAU - Weinstein, Milton C
AU  - Weinstein MC
AD  - Harvard T. H. Chan School of Public Health, Boston, MA, USA.
FAU - Parks, Philip D
AU  - Parks PD
AD  - Exact Sciences Corporation, Madison, WI, USA.
LA  - eng
PT  - Journal Article
DEP - 20200411
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Biomarkers, Tumor)
SB  - IM
EIN - J Med Econ. 2021 Jan-Dec;24(1):781. PMID: 34126835
MH  - Adenoma/*diagnosis
MH  - Aged
MH  - Biomarkers, Tumor
MH  - Colonoscopy/adverse effects/economics
MH  - Colorectal Neoplasms/*diagnosis
MH  - Costs and Cost Analysis
MH  - Early Detection of Cancer/*economics/*methods
MH  - Female
MH  - Health Expenditures/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Middle Aged
MH  - Models, Econometric
MH  - Occult Blood
MH  - Patient Compliance
MH  - Patient Preference
MH  - Sensitivity and Specificity
MH  - United States
OTO - NOTNLM
OT  - B23
OT  - B41
OT  - C01
OT  - C51
OT  - Colorectal cancer screening
OT  - FIT
OT  - colonoscopy
OT  - mt-sDNA
EDAT- 2020/02/18 06:00
MHDA- 2021/04/07 06:00
CRDT- 2020/02/18 06:00
PHST- 2020/02/18 06:00 [pubmed]
PHST- 2021/04/07 06:00 [medline]
PHST- 2020/02/18 06:00 [entrez]
AID - 10.1080/13696998.2020.1730123 [doi]
PST - ppublish
SO  - J Med Econ. 2020 Jun;23(6):581-592. doi: 10.1080/13696998.2020.1730123. Epub 2020 
      Apr 11.