Cost-effectiveness of multitarget stool DNA testing for colorectal cancer screening in Chinese primary healthcare settings: a modelling study.
The mt-sDNA colorectal cancer screening program is cost-effective compared to no screening, with an ICER of CNY 43,627 per QALY gained.
Where it sits
this study against the rest of the melanotan i (mt-i) corpusSummary and findings
This study evaluated the cost-effectiveness of a one-time multitarget stool DNA (mt-sDNA) colorectal cancer screening program in Chinese primary healthcare settings. The program involved 749,517 participants aged 45-64 years, with an incremental cost-effectiveness ratio (ICER) of CNY 43,627 per quality-adjusted life-year (QALY) gained. The findings suggest that mt-sDNA screening is cost-effective compared to no screening.
Abstract
<h4>Aim</h4>To evaluate the cost-effectiveness of a one-time mt-sDNA-based colorectal cancer screening program compared with no screening, using real-world data from a government-led population-based screening program in Harbin Municipality of China.<h4>Methods</h4>This modelling study was based on a real-world mt-sDNA CRC screening program in Chinese primary healthcare settings. The program targeted residents aged 45-64 years without a prior history of CRC. A decision analytic model was developed from the healthcare system perspective to compare mt-sDNA screening with a hypothetical no-screening scenario. Costs included mt-sDNA testing, diagnostic colonoscopy after positive results, adenoma resection, and colorectal cancer treatment by disease stage. Effectiveness was measured in quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), assessed against a willingness-to-pay threshold of CNY 166,744 per QALY gained. Costs and QALYs were discounted at 5% annually over a lifetime horizon. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis with 10,000 simulations were conducted.<h4>Results</h4>Among 749,517 participants, 79,169 had positive mt-sDNA results and 17,364 completed diagnostic colonoscopy, corresponding to a colonoscopy adherence rate of 21.93%. In the base-case analysis, mt-sDNA screening incurred CNY 264 higher lifetime costs and yielded an additional 0.006 QALYs per person versus no screening. The mt-sDNA screening was cost-effective with an ICER of CNY 43,627 per QALY gained. The cost-effectiveness results were particularly sensitive to colonoscopy adherence (ranging from CNY 94,907 to 10,037 per QALY as adherence varied from 10% to 100%) and to the unit cost of the mt-sDNA test (ranging from CNY 22,113 to 65,140 per QALY with <i>a</i> ± 50% variation in cost). All ICERs remained below the cost-effectiveness threshold.<h4>Conclusions</h4>The mt-sDNA screening is cost-effective compared to no screening. These findings provide economic evidence to support the large-scale adoption of mt-sDNA-based screening in China.
Background
This paper addresses the cost-effectiveness of multitarget stool DNA (mt-sDNA) testing for colorectal cancer screening, a significant public health concern. Previous studies have indicated varying effectiveness and cost implications of different screening methods. Understanding the economic viability of mt-sDNA screening in a population-based setting is crucial for informing healthcare policy and resource allocation.
Methods
This modeling study utilized data from a government-led population-based screening program in Harbin Municipality, China. The target population included residents aged 45-64 years without prior colorectal cancer history. The primary outcome measure was the incremental cost-effectiveness ratio (ICER) assessed against a willingness-to-pay threshold of CNY 166,744 per QALY gained, with costs and QALYs discounted at 5% annually over a lifetime horizon.
Results
In the base-case analysis, mt-sDNA screening resulted in an incremental cost of CNY 264 and an additional 0.006 QALYs per person compared to no screening. The ICER was calculated at CNY 43,627 per QALY gained, remaining below the established cost-effectiveness threshold. Sensitivity analyses showed that the ICER was particularly sensitive to variations in colonoscopy adherence and the unit cost of the mt-sDNA test.
Interpretation
The findings suggest that mt-sDNA screening is cost-effective compared to no screening, although the effect size is small with only 0.006 QALYs gained. The sensitivity of the results to colonoscopy adherence and test costs indicates that the conclusions may vary significantly under different conditions. This highlights the importance of considering local healthcare contexts when implementing screening programs.
Key findings
- 79,169 participants had positive mt-sDNA results out of 749,517, n=749517.
- 21.93% colonoscopy adherence rate after positive mt-sDNA results.
- mt-sDNA screening incurred CNY 264 higher lifetime costs per person versus no screening.
- mt-sDNA screening yielded an additional 0.006 QALYs per person compared to no screening.
- ICER of mt-sDNA screening was CNY 43,627 per QALY gained.
- ICERs varied from CNY 94,907 to 10,037 per QALY as colonoscopy adherence varied from 10% to 100%.
Limitations
- modeling study, not a direct clinical trial
- sensitivity to colonoscopy adherence rates
- cost-effectiveness based on real-world data, which may vary
- potential variability in results due to test cost fluctuations