Economic Evaluations of Cancer Screening Tests in the US: A Systematic Literature Review (SLR)

OBJECTIVES: Cancer screening can improve health outcomes and decrease treatment costs. This study aimed to systematically summarize economic evaluation results of screenings across multiple cancer types.

METHODS: An SLR was conducted using PICOS criteria by searching Embase, Medline, Econlit, Cochrane and Gray literature databases. US economic evaluations comparing cancer screenings vs no screenings published during 2008-2023 in English were included.

RESULTS: 73 studies were abstracted. In breast cancer screening (n=13), cost per quality-adjusted life year (QALY) gained ranged from $6,490 to $228,427, influenced by factors such as age, breast density, and screening intervals. Life year (LY) gained per patient ranged 0.016-0.211 in lifetime models. Cervical cancer screenings (n=2) were cost-effective (CE) (cost/QALY gained: $17,204-$19,321). Colorectal cancer screening tests (colonoscopy, FIT, FOBT, mt-sDNA, CTC) all had positive LY gained (e.g., colonoscopy LY gained: 0.022-0.291) and were CE/dominant in the majority of analyses (n=35). For gastric cancer, endoscopy screening was only CE among Asian Americans as a one-time surveillance; serum pepsinogen screening was CE among smokers. For head and neck cancer (n=2), nasopharyngeal screening was CE (cost/QALY gained: $113,341), and one-time oral examination dominated. Low-dose CT for lung cancer (n=8) had positive LY gained (0.0036-0.045) with various values by populations’ risk level: CE among patients with 30 pack-year smoking history; not CE among nonsmokers. Adding multi-cancer early detection tests (n=6) to usual care demonstrated CE (cost/QALY gained: <$100,000) with LY gained ranging 0.10-0.18. PSA for prostate cancer had a LY gained of 0.027-0.105, with variant CE results depending on screening protocols.

CONCLUSIONS: Cancer screenings improve life expectancy and provide good economic value in the majority of scenarios assessed, with increased value among higher risk groups.