Background In 2014, the Centers for Medicare and Medicaid Services (CMS) began covering a multitarget stool DNA (mtSDNA) test for colorectal cancer (CRC) screening of Medicare beneficiaries. In this study, we evaluated whether mtSDNA testing is a cost-effective alternative to other CRC screening strategies reimbursed by CMS, and if not, under what conditions it could be. Methods We use three independently-developed microsimulation models to simulate a cohort of previously unscreened US 65-year-olds who are screened with triennial mtSDNA testing, or one of six other reimbursed screening strategies. Main outcome measures are discounted life-years gained (LYG) and lifetime costs (CMS perspective), threshold reimbursement rates, and threshold adherence rates. Outcomes are expressed as the median and range across models. Results Compared to no screening, triennial mtSDNA screening resulted in 82 (range: 79–88) LYG per 1,000 simulated individuals. This was more than for five-yearly sigmoidoscopy (80 (range: 71–89) LYG), but fewer than for every other simulated strategy. At its 2017 reimbursement rate of $512, mtSDNA was the most costly strategy, and even if adherence were 30% higher than with other strategies, it would not be a cost-effective alternative. At a substantially reduced reimbursement rate ($6–18), two models found that triennial mtSDNA testing was an efficient and potentially cost-effective screening option. Conclusions Compared to no screening, triennial mtSDNA screening reduces CRC incidence and mortality at acceptable costs. However, compared to nearly all other CRC screening strategies reimbursed by CMS it is less effective and considerably more costly, making it an inefficient screening option.
Bibliographical noteFunding Information:
This work was supported by contract HHSM-500-2012-00008I with The MITRE Corporation. The models used in the analysis are supported by the National Institutes of Health under National Cancer Institute Grant U01 CA152959 and U01 CA199335 as part of the Cancer Intervention and Surveillance Modeling Network (CISNET). The authors did not receive any other financial support for this work. Model results and the contents of this manuscript are the sole responsibility of the investigators and do not necessarily represent the official views of the National Cancer Institute. The MITRE Corporation and National Institutes of Health had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We thank Joel V. Brill, MD, of Predictive Health, LLC for his assistance with coding of colorectal cancer screening procedures; Janet Brock, Linda Gousis, JD, and Stephanie Bartee of the Centers for Medicare and Medicaid Services for providing data on reimbursement for colorectal cancer screening procedures; Craig Parzynski, MS, of Yale University and Martha Morton of Reimbursement Principles for assistance with estimation of the reimbursement for treatment of colonoscopy complications; Angela Mariotto, PhD, of the National Cancer Institute (NCI), for providing estimates of the cost of cancer care; and Eric ?Rocky? Feuer, PhD, for continued support of the CISNET Colorectal Cancer Working Group. We also thank Juan Arroyo, PhD, for project management support. Personal communication from Craig Parzynski regarding analysis of colonoscopy frequencies was for work he conducted under contract HHSM-500-2013-13018I, Task Order HHSM-500-T0002, Measure & Instrument Development and Support (MIDS): Development, Reevaluation, and Implementation of Outpatient Outcome/Efficiency Measures, funded by the Centers for Medicare & Medicaid Services, an agency of the US Department of Health and Human Services.
© 2019 Naber et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.