Cost Studies

Using real-world adherence rates, simulation based on modeling data from both Medicare and Medicaid perspectives has shown that multitarget stool DNA (mt-sDNA) test offers a cost-effective option for colorectal cancer (CRC) screening.1,2

Modeling data also demonstrated that increased Cologuard® test use leads to reduced need for screening and surveillance colonoscopies and fewer adverse events resulting in overall cost-savings and improved detection of CRC cases.3

Increased Cologuard test use would reduce CRC screening costs by approximately 4% over 10 years3

Overall screening program costs would be reduced by 2% over 10 years3

Increased Cologuard test use could lead to over $4 million in cost savings, and more cancers detected while maintaining screening adherence rates over 10 years3

INCREMENTAL ECONOMIC OUTCOMES FROM THE IDN PERSPECTIVE (AGES 45-75 YEARS)3,a

Status quo (6% mt-sDNA/ 11% FIT/83% CY) Increased mt-sDNA (28% mt-sDNA/ 9% FIT/63% CY) Incremental costs compared to status quo (difference between status quo and increased mt-sDNA) %c
CRC screening $392,018,192 $376,362,864 -$15,655,327 -3.99
Surveillance colonoscopies $18,935,870 $18,662,285 -$273,586 -1.44
Diagnostic colonoscopies $5,888,874 $8,234,466 $2,345,592 39.83
AEs $73,020,075 $70,688,413 -$2,331,663 -3.19
CRC treatmentd $182,730,298 $183,248,638 $518,340 0.28
Aggregate costse $1,122,409,102 $1,103,226,070 -$19,183,032 -1.71

Table adapted from Hathway, 20203

INCREMENTAL ECONOMIC OUTCOMES FOR THE PAYER PERSPECTIVE (AGES 45-75 YEARS)3,a

Status quo (6% mt-sDNA/ 11% FIT/83% CY) Increased mt-sDNA (28% mt-sDNA/ 9% FIT/63% CY) Incremental costs compared to status quo (difference between status quo and increased mt-sDNA) %c
CRC screening $444,144,314 $439,518,233 -$4,626,081 -1.04
Surveillance colonoscopies $20,767,798 $20,467,915 -$299,883 -1.44
Diagnostic colonoscopies $6,451,959 $9,020,673 $2,568,714 39.81
AEs $73,020,075 $70,688,413 -$2,331,663 -3.19
CRC treatmentd $182,730,298 $183,248,638 $518,340 0.28
Aggregate costse $727,114,444 $722,943,871 -$4,170,573 -0.57

Table adapted from Hathway, 20203

  • Compared to FIT and colonoscopy, a Markov cohort simulation model showed there can be considerable cost-savings from both payer and IDN perspectives,a with increased use of mt-sDNA for CRC screening and significantly higher savings from the IDN perspective3,b

In a population of 1 million covered lives, the 10-year incremental cost-savings incurred by increasing mt-sDNA utilization among 45 to 75 year olds was ~$19.18 million for the IDN and ~$4.17 million for the payer3

  • Increased diagnostic colonoscopy costs were offset by reductions in screening colonoscopies, surveillance colonoscopies, and AEs for both perspectives3
  • Increased mt-sDNA utilization led to fewer colonoscopies, fewer AEs, and lower overall costs from both IDNs and payers, reducing overall screening program costs and increasing the number of cancers detected while maintaining screening adherence rates over 10 years3

Related Topics

Footnotes

  1. IDN and payer perspectives both incorporate direct medical costs, which were micro-costed and included procedural (diagnostic and surveillance colonoscopies), AEs, and CRC treatment component. Procedural and AE treatment costs were derived from the Centers for Medicare and Medicaid Services (CMS) CPT codes and the Healthcare Cost and Utilization Project (HCUP), respectively.
  2. Integrated delivery networks (IDN) consist of integrated provider networks, such as hospitals, urgent care centers, and laboratories.
  3. Percentage is calculated as difference (45-75) / status quo (45-75) x 100 (%).
  4. CRC treatment costs were derived from the literature estimates.
  5. Aggregate cost for the payer perspective includes indirect and direct nonmedical CRC screening costs. Direct nonmedical (eg, patient navigation) and indirect (eg, administration) costs were included in the screening program costs for the IDN perspective. It was assumed that costs were not incurred for IDNs for stool-based screening tests or bowel preparation for colonoscopies.

List of definitions

AE: adverse event; CMS: Centers for Medicare and Medicaid Services; CRC: colorectal cancer; CY: colonoscopy; FIT: fecal immunochemical test; HCUP: Healthcare Cost and Utilization Project; IDN: integrated delivery networks; mt-sDNA: multitarget stool DNA.


References

  1. Fisher DA, Karlitz JJ, Jeyakumar S, et al. Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population. J Med Econ. 2021;24(1):654-664.
  2. Karlitz JJ, Fendrick AM, Bhatt J, et al. Cost-Effectiveness of Outreach Strategies for Stool-Based Colorectal Cancer Screening in a Medicaid Population. Popul Health Manag. 2022;25(3):343-351.
  3. Hathway JM, Miller-Wilson LA, Jensen IS, et al. Projecting total costs and health consequences of increasing mt-sDNA utilization for colorectal cancer screening from the payer and integrated delivery network perspectives [published correction appears in J Med Econ. 2021 Jan-Dec;24(1):781]. J Med Econ. 2020;23(6):581-592.