Liquid biopsy not cost-effective as alternative to colonoscopy for CRC screening
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Key takeaways:
- Colonoscopy was the most cost-effective strategy with an associated mean cost of $9,037 per person.
- The cost of liquid biopsy would have to decrease to $56.16 in order to be cost-effective vs. no screening.
The cost of liquid biopsy for second-line colorectal cancer screening was not cost-effective and would have to be reduced by 66% to increase uptake among the general population, according to data in JAMA Network Open.
“New blood tests or liquid biopsies (LBs) using circulating tumor DNA–based markers are in development for single cancer and multicancer early detection, including CRC,” Zainab Aziz, BS, of the department of medicine at Columbia University Irving Medical Center, and colleagues wrote. “These tests have better performance than previous blood-based cancer detection tests and LBs may present a more appealing CRC screening option, especially among individuals who are unscreened.”
They continued: “While there has been increasing investment in LB for its potential to detect early cancer, it remains unclear whether it is a cost-effective CRC screening strategy in the U.S.”
Using a state-transition, cohort-level Markov model based on cancer incidence and mortality data from the Surveillance, Epidemiology and End Results registries, researchers estimated the cost-effectiveness of five CRC screening strategies compared with no screening in a simulated cohort of individuals aged 45 years with an average risk for cancer.
Evaluated strategies included colonoscopy, LB, LB after nonadherence to colonoscopy (C-LB), stool DNA and fecal immunochemical test. Researchers assumed adherence to first-line colonoscopy, stool DNA and FIT was 60.6% vs. 100% for LB.
Results from the simulation showed colonoscopy was the most cost-effective strategy with an incremental cost-effectiveness ratio of $28,071 per life-year gained, which correlated to a mean cost of $9,037 per person and 35.67 life-years gained. FIT and stool-DNA had fewer life-years gained compared with colonoscopy (35.62 and 35.64, respectively), although FIT was less expensive at $8,223.
While C-LB had the greatest life-years gained (35.68) and reduced total cancers and cancer deaths compared with colonoscopy, it was not cost-effective at a cost of $12,006, with researchers reporting an ICER of $377,538 per life-years gained above the willingness-to-pay threshold of $100,000 per life-years gained.
According to results, C-LB would have to be reduced by 66% — from $949 to $324 — to become cost-effective, and LB would have to drop to $56.16 to be cost-effective vs. no screening in the current simulated model.
“In this economic evaluation of LB for CRC screening in the U.S., screening with LB was not cost-effective compared with current screening strategies,” Aziz and colleagues concluded. “Furthermore, for individuals who refused traditional screening, it was not cost-effective to offer LB over no screening. LB tests for CRC screening may become cost-effective in the future if they are significantly less expensive or if polyp detection is introduced coupled with a decrease in cost.”
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