Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened
Menée aux Etats-Unis à l'aide d'un modèle de simulation, cette étude estime le rapport coût-efficacité de cinq stratégies de dépistage du cancer colorectal (coloscopie, biopsie liquide, biopsie liquide après non observance de la coloscopie, test FIT et test ADN fécal) par rapport à l'absence de dépistage
Importance : Despite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening.
Objective : To estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US.
Design, Setting, and Participants : In this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy–liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy.
Exposures : No screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy–liquid biopsy hybrid screening.
Main Outcomes and Measures : Model outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained.
Results : This study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy–liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy–liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly.
Conclusions and Relevance : In this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.
JAMA Network Open , article en libre accès, 2022