The research published in JAMA Network Open indicates that conventional colonoscopy is the most cost-effective method for colorectal cancer (CRC) screening in average-risk adults in the US, compared to circulating tumor DNA-based methods.
Key points from the study include:
Colonoscopy’s Cost-Effectiveness: The study, led by medical student Zainab Aziz under senior author Chin Hur at Columbia University Irving Medical Center, found that colonoscopy remains the most cost-effective tool for CRC screening. For liquid biopsy-based tests to be a viable option, they need to become more affordable and improve in detecting early-stage cancers and pre-cancerous lesions.
Low Screening Rates in the US: Despite recommendations from the US Preventive Services Task Force for CRC screening starting at 45 years of age for those at average risk, screening rates in the US are relatively low, around 60%.
Study Methodology: The researchers used a Markov model-based economic analysis on a simulated cohort of 45-year-olds with average CRC risk. They compared life expectancy, total cost, and cost per life-year gained across various screening methods: colonoscopy, stool DNA testing (S-DNA), fecal immunochemical testing (FIT), liquid biopsy, and liquid biopsy post-colonoscopy refusal.
Adherence Assumptions and Cost-Effectiveness: The study assumed 100% adherence to liquid biopsy-based screening and 60.6% adherence to other methods. Cost-effectiveness was based on a US willingness-to-pay threshold of $100,000 per year of life gained.
Results of the Study: Colonoscopy showed the greatest cost-effectiveness with an incremental cost-effectiveness ratio of just over $28,000 per life-year gained. The combined colonoscopy-liquid biopsy method had a higher life-year gain but was much less cost-effective, with over $377,500 per life year.
Future of Liquid Biopsy-Based Screening: While currently not cost-effective, improvements in technology could make liquid biopsy-based CRC screening a more viable option in the future.
Implications for Cancer Screening and Disparities: The study highlights the importance of evaluating new technologies for cancer screening and their potential impact on reducing racial and ethnic disparities in CRC outcomes. However, there’s a caution against inadvertently increasing barriers to screening, especially for individuals without insurance or with high-deductible insurance plans, due to the higher costs of blood-based tests.
This research underscores the need for balancing innovation in cancer screening with cost-effectiveness and accessibility, particularly in the context of healthcare disparities.