S182 Cost-Effectiveness of Outreach Strategies for Stool-Based Colorectal Cancer Screening in a Medicaid Population

Abstract

Introduction: Outreach, including patient navigation, has been shown to increase the uptake of colorectal cancer (CRC) screening in underserved populations. This analysis evaluates the cost-effectiveness of triennial multi-target stool DNA (mt-sDNA), where each test includes centralized patient navigation support, versus outreach, with or without a mailed annual fecal immunochemical test (FIT), in a simulated Medicaid population. Methods: A microsimulation model was used to estimate the incremental cost-effectiveness ratio using quality-adjusted life years (QALY), direct costs and clinical outcomes in a cohort of Medicaid beneficiaries aged 50 – 64 over a lifetime time horizon. For annual FIT screening, we modeled two outreach scenarios: a mailed letter encouraging CRC screening completion along with instructions about how to obtain a FIT test (with no actual FIT test provided); and outreach via a mailed letter encouraging CRC screening completion along with a FIT test. The base case model explored scenarios of either 100% adherence or real-world reported adherence (51.3% for mt-sDNA, 21.1% for outreach with FIT and 12.3% for outreach without FIT) with or without real-world adherence for follow-up colonoscopy (66.7% for all). Costs and outcomes were discounted at 3.0%. Results: When 100% adherence is assumed for both the screening test and follow-up colonoscopy, outreach with or without FIT results in higher incidence reduction and higher mortality reduction compared to mt-sDNA (Table 1); mt-sDNA also cost more and was less effective compared to outreach with or without FIT at 100% adherence to both screening tests and follow-up colonoscopy (Figure 1). When real-world adherence rates were considered for screening strategies (with 100% adherence for follow-up colonoscopy), mt-sDNA resulted in the greatest reduction in incidence and mortality from CRC compared to outreach with or without FIT for incidence and mortality (Table 1); mt-sDNA was also cost-effective versus outreach with and without FIT ($32,150/QALY and $22,707/QALY, respectively) (Figure 1). mt-sDNA remained cost-effective versus FIT, with or without outreach, under real-world adherence rates for follow-up colonoscopy (Figure 1). Conclusion: Patient outreach/navigation interventions and associated real-world adherence rates to screening tests should be considered when evaluating the cost effectiveness of CRC screening strategies in underserved populations.Table 1.: Clinical and cost outcomes.Figure 1.: Incremental cost-effectiveness plane (A) mt-sDNA versus outreach + FIT (B) mt-sDNA versus outreach alone.