The Use of a Non-Invasive Biomarker for Colorectal Cancer Screening: A Comparative Cost-Effectiveness Modeling Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Decision Model Framework
2.2. Clinical Transition Probabilities
2.3. Studies on Diagnostic Accuracy for M3
2.4. Cost Estimates
2.5. Sensitivity Analysis
2.6. Cost-Effectiveness Analysis
3. Results
4. Discussion
4.1. Major Findings
4.2. Limitations of FIT
4.3. Strengths of M3CRC When Compared with FIT and Colonoscopy
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Rate | Estimate | Reference |
---|---|---|
Sensitivity of FIT (cutoff value = 20 µg/g) in detecting colorectal cancer | 73.0% | [16] |
Specificity of FIT (cutoff value = 20 µg/g) in detecting colorectal cancer | 91.9% | [27] |
Sensitivity of M3CRC in detecting a composite measure of NAA + AA + CRC | 66.5% | [12] |
Specificity of M3CRC in detecting a composite measure of NAA + AA + CRC | 83.8% | [12] |
Compliance rate of FIT | 60.0% | [16] |
Compliance rate of M3CRC | 99.0% | [12] |
Compliance of Colonoscopy | 98.9% | [22] |
Compliance rate of Colonoscopy after a positive result | 100% | [28] |
Rate of polypectomy of FIT | 73.0% | [29] |
Rate of polypectomy of M3CRC | 83.9% | [12] |
Polypectomy bleeding rate | 0.98% | [30] |
Polypectomy perforation rate | 0.08% | [30] |
Morality due to perforation | 0.0029% | [30] |
Cancer prevented by FIT | 21.0% | [31] |
Cancer prevented by Colonoscopy | 54.0% | [22] |
Cancer prevented by M3CRC | 51.5% | [12] |
Staging of CRC at diagnosis | ||
I | 11.3% | [32] |
II | 25.4% | [32] |
III | 32.4% | [32] |
IV | 31.0% | [32] |
Annual mortality of CRC patients at various stages of disease (1 year) | ||
I | 1.0% | [33] |
II | 4.5% | [33] |
III | 8.7% | [33] |
IV | 43.0% | [33] |
Cost Item | Baseline Value (USD) | Reference |
---|---|---|
One kit of FIT | 19 | [16] |
M3CRC | 64 | Internal source |
Colonoscopy | 1259 | [26,34] |
Consultation fee | 96 | [26,34] |
Bleeding | 3320 | [26,34] |
Histopathological examination | 142 | [26,34] |
Perforation | 10,790 | [26,34] |
Treatment for the stage I of CRC | 17,071 | [26,34] |
Diagnosis | 6091 | [26,34] |
Treatment | 10,377 | [26,34] |
Follow-up | 603 | [26,34] |
Treatment for the stage II of CRC | 19,755 | [26,34] |
Diagnosis | 6091 | [26,34] |
Treatment | 13,061 | [26,34] |
Follow-up | 603 | [26,34] |
Treatment for the stage III of CRC | 26,883 | [26,34] |
Diagnosis | 6091 | [26,34] |
Treatment | 20,189 | [26,34] |
Follow-up | 603 | [26,34] |
Treatment for the stage IV of CRC | 45,115 | [26,34] |
Diagnosis | 6091 | [26,34] |
Treatment | 38,422 | [26,34] |
Follow-up | 603 | [26,34] |
Screening Method | No Screening | FIT | M3CRC | Colonoscopy |
---|---|---|---|---|
Total number CRC cases | 3233 | 3087 | 1611 | 1575 |
Total loss of cancer-related life years | 5635 | 5297 | 2783 | 2719 |
Cases of CRC prevented | 0 | 146 | 1622 | 1657 |
Proportion of CRC case prevented (%) | 0 | 4.5 | 50.2 | 51.3 |
Life-years saved | 0 | 339 | 2852 | 2917 |
Number of procedures | ||||
FIT | 0 | 236,913 | 0 | 0 |
M3CRC | 0 | 0 | 712,584 | 0 |
Colonoscopy | 0 | 36,670 | 419,173 | 509,496 |
Diagnostic (without polypectomy) | 0 | 9901 | 67,487 | 141,655 |
Therapeutic (with polypectomy) | 0 | 26,769 | 351,686 | 367,841 |
Number of complications | ||||
Bleeding | 0 | 73 | 838 | 1019 |
Perforations | 0 | 29 | 335 | 403 |
Costs (USD) | ||||
FIT | 0 | 4,247,330 | 0 | 0 |
M3CRC | 0 | 0 | 37,385,539 | 0 |
Colonoscopy | 0 | 40,555,839 | 408,885,333 | 526,128,915 |
Polypectomy | 0 | 3,100,114 | 35,922,369 | 39,807,084 |
Bleeding | 0 | 973,819 | 9,818,076 | 12,633,307 |
Perforations | 0 | 258,360 | 2,604,796 | 3,314,825 |
Care of CRC | ||||
Stage I | 4,050,827 | 3,839,170 | 2,010,230 | 1,964,971 |
Stage II | 14,828,981 | 14,046,379 | 7,355,408 | 7,189,266 |
Stage III | 36,148,483 | 34,219,225 | 17,920,737 | 17,514,640 |
Stage IV | 170,486,718 | 160,919,746 | 84,332,191 | 82,394,622 |
Total | 225,515,010 | 262,159,983 | 606,234,678 | 690,947,627 |
Total costs per life-years saved | - | 773,894 | 212,553 | 236,909 |
ICER vs. no screening | 108,176 | 133,485 | 159,586 | |
ICER vs. FIT | 136,896 | 166,342 | ||
ICER vs. M3CRC | 1,316,491 |
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Wong, M.C.S.; Huang, J.; Wong, Y.-Y.; Ko, S.; Chan, V.C.W.; Ng, S.C.; Chan, F.K.L. The Use of a Non-Invasive Biomarker for Colorectal Cancer Screening: A Comparative Cost-Effectiveness Modeling Study. Cancers 2023, 15, 633. https://doi.org/10.3390/cancers15030633
Wong MCS, Huang J, Wong Y-Y, Ko S, Chan VCW, Ng SC, Chan FKL. The Use of a Non-Invasive Biomarker for Colorectal Cancer Screening: A Comparative Cost-Effectiveness Modeling Study. Cancers. 2023; 15(3):633. https://doi.org/10.3390/cancers15030633
Chicago/Turabian StyleWong, Martin C. S., Junjie Huang, Yuet-Yan Wong, Samantha Ko, Victor C. W. Chan, Siew C. Ng, and Francis K. L. Chan. 2023. "The Use of a Non-Invasive Biomarker for Colorectal Cancer Screening: A Comparative Cost-Effectiveness Modeling Study" Cancers 15, no. 3: 633. https://doi.org/10.3390/cancers15030633