Mo1676 COST EFFECTIVENESS OF MULTI-TARGET STOOL DNA TEST VERSUS COLONOSCOPY OR FECAL IMMUNOCHEMICAL TEST FOR COLORECTAL CANCER SCREENING AMONG ALASKA NATIVE PEOPLE

Abstract

Alaska Native people have higher incidence and mortality from colorectal cancer (CRC) and lower CRC screening rates than U.S. whites. Alaska’s large and predominately roadless geography presents CRC screening challenges, particularly for endoscopy. The objective of this study was to estimate the cost-effectiveness of the multi-target stool DNA test (MT-sDNA) compared with colonoscopy and fecal immunochemical test (FIT) for Alaska Native people. A Markov model was used to evaluate effects of three CRC screening strategies for Alaska Native adults aged 40-75: colonoscopy every 10 years, annual FIT, or MT-sDNA testing every three years, over a 40-year period. An Alaska Native health-system perspective and Alaska Native-specific and national data were updated from previous models to incorporate new evidence on test performance; probabilistic sensitivity analyses explored perfect and imperfect screening adherence. The main outcome measures were CRC incidence and mortality; cost; quality-adjusted life years (QALYs); and incremental cost-effectiveness ratio (ICER). With perfect adherence, CRC incidence was reduced by 51.7% (95% CI: 46.3%-55.9%) using colonoscopy, 60.7% (95% CI: 56.5%-64.2%) using annual FIT, and 65.7% (95% CI: 62.9%-68.3%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15 QALYs per person with colonoscopy, 0.17 QALYs per person with FIT, and 0.19 QALYs per person with MT-sDNA. Screening by colonoscopy at ten-year intervals is the most expensive strategy, about $110M more than MT-sDNA and $127M more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs/person vs. 0.05 QALYS/person by FIT and 0.06 QALYS/person by colonoscopy. Probabilistic sensitivity analyses supported the findings of the base-case analysis. Under perfect and imperfect adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs range from $1,740 to $75,868 per QALY saved) as compared with FIT and colonoscopy. Each strategy reduced costs and increased QALYs in comparison with no screening. Screening by MT-sDNA results in the largest savings of QALYs, in all adherence scenarios. In a Markov model analysis, we found that screening by MT-sDNA in the Alaska Native population is cost-effective as compared to screening by colonoscopy and FIT, for a wide range of adherence scenarios.