Cost-Effectiveness of CT Colonography Under Real-World Colorectal Cancer Screening Adherence
Author(s)
Szu-Yu Kao, PhD1, Maria X. Sanmartin, PhD2, Judy Yee, MD3, Kevin J. Chang, MD4, Courtney A. Moreno, MD5, Cecelia Brewington, MD6, David H. Bruining, MD7, Eric W. Christensen, PhD8, Elizabeth Y. Rula, PhD8, Pina C. Sanelli, MD2;
1Siemens Healthineers, Health Economist, Malvern, PA, USA, 2Northwell, New York City, NY, USA, 3Montefiore Health System, New York City, NY, USA, 4Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 5Emory University School of Medicine, Atlanta, GA, USA, 6Ochsner Health, New Orleans, LA, USA, 7Mayo Clinic, Rochester, MN, USA, 8Harvey L. Neiman Health Policy Institute, Reston, VA, USA
1Siemens Healthineers, Health Economist, Malvern, PA, USA, 2Northwell, New York City, NY, USA, 3Montefiore Health System, New York City, NY, USA, 4Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, 5Emory University School of Medicine, Atlanta, GA, USA, 6Ochsner Health, New Orleans, LA, USA, 7Mayo Clinic, Rochester, MN, USA, 8Harvey L. Neiman Health Policy Institute, Reston, VA, USA
OBJECTIVES: To evaluate the cost-effectiveness of CT colonography (CTC) for colorectal cancer (CRC) screening by race (Black and White) and sex, considering real-world screening adherence, in light of the Centers for Medicare and Medicaid Services (CMS) coverage beginning in 2025.
METHODS: A microsimulation model compared CRC screening strategies in average-risk U.S. adults by race and sex, incorporating disease progression and real-world screening adherence for optical colonoscopy (OC) or fecal immunochemical test (FIT). Five screening strategies were compared: (1) status quo (real-world OC and FIT screening utilization); (2) CTC every 5 years; (3) OC every 10 years; (4) annual FIT; and (5) multitarget stool DNA test every 3 years. Outcomes included CRC cases, costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs), analyzed from a societal perspective at a willingness-to-pay threshold of $100,000/QALY gained. The model was calibrated using 2010-2019 National Health Interview Survey and Surveillance, Epidemiology, and End Results data.
RESULTS: Under the status quo, Black adults showed higher CRC incidence and greater preference for FIT over OC than White adults (FIT-to-OC utilization ratio: 1.55-1.60 in Black adults vs. 1.36-1.47 in White adults). Compared to the status quo, the CTC strategy yielded more CRC cases and fewer QALYs among White adults, but fewer cases and more QALYs among Black adults. Both the status quo and CTC strategies outperformed all other strategies in both Black and White adults. For White adults, both the status quo and CTC were undominated, with the status quo being cost-effective (ICER=$73,428 and $34,998/QALY gained for men and women, respectively). For Black adults, CTC was cost-effective and outperformed the status quo strategy.
CONCLUSIONS: CTC could be cost-effective for CRC screening under real-world screening adherence, particularly in Black adults. Its advantages—including having OC-comparable test performance, reduced screening burden, and improved utilization—support CMS coverage for CTC screening.
METHODS: A microsimulation model compared CRC screening strategies in average-risk U.S. adults by race and sex, incorporating disease progression and real-world screening adherence for optical colonoscopy (OC) or fecal immunochemical test (FIT). Five screening strategies were compared: (1) status quo (real-world OC and FIT screening utilization); (2) CTC every 5 years; (3) OC every 10 years; (4) annual FIT; and (5) multitarget stool DNA test every 3 years. Outcomes included CRC cases, costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs), analyzed from a societal perspective at a willingness-to-pay threshold of $100,000/QALY gained. The model was calibrated using 2010-2019 National Health Interview Survey and Surveillance, Epidemiology, and End Results data.
RESULTS: Under the status quo, Black adults showed higher CRC incidence and greater preference for FIT over OC than White adults (FIT-to-OC utilization ratio: 1.55-1.60 in Black adults vs. 1.36-1.47 in White adults). Compared to the status quo, the CTC strategy yielded more CRC cases and fewer QALYs among White adults, but fewer cases and more QALYs among Black adults. Both the status quo and CTC strategies outperformed all other strategies in both Black and White adults. For White adults, both the status quo and CTC were undominated, with the status quo being cost-effective (ICER=$73,428 and $34,998/QALY gained for men and women, respectively). For Black adults, CTC was cost-effective and outperformed the status quo strategy.
CONCLUSIONS: CTC could be cost-effective for CRC screening under real-world screening adherence, particularly in Black adults. Its advantages—including having OC-comparable test performance, reduced screening burden, and improved utilization—support CMS coverage for CTC screening.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE95
Topic
Economic Evaluation
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology