THE POTENTIAL CLINICAL VALUE OF REDUCING EMERGENCY DEPARTMENT (ED) INVOLVEMENT AT CANCER DIAGNOSIS THROUGH MULTI-CANCER EARLY DETECTION (MCED) TESTING
Author(s)
Amy Pinsent, MS1, Ali Tafazzoli, PhD2, Pedro Saramago, MSc, PhD3, Weicheng Ye, MPH4, Anuraag R. Kansal, PhD2, Denise Zou, MS4, A Mark Fendrick, MD5;
1Thermo Fisher Scientific, London, United Kingdom, 2GRAIL, Inc., Menlo Park, CA, USA, 3Thermo Fisher Scientific, Lisbon, Portugal, 4Thermo Fisher Scientific, Waltham, MA, USA, 5University of Michigan, Ann Arbor, MI, USA
1Thermo Fisher Scientific, London, United Kingdom, 2GRAIL, Inc., Menlo Park, CA, USA, 3Thermo Fisher Scientific, Lisbon, Portugal, 4Thermo Fisher Scientific, Waltham, MA, USA, 5University of Michigan, Ann Arbor, MI, USA
OBJECTIVES: Across cancer types, a substantial proportion of diagnoses—particularly among late-stage cases—occur through ED involvement rather than through timely, non-emergency diagnostic pathways. This diagnostic route is associated with poorer survival, even after adjustment for socioeconomic factors, comorbidities, and cancer stage at diagnosis. While prior cost-effectiveness analyses of MCED screening have focused primarily on benefits from reduction in late stage, this study evaluated how these analyses may be impacted by adding the avoidance of ED involvement, including among MCED-detected cancers with no modeled stage shift.
METHODS: We extended a previously published cost-effectiveness model to compare annual MCED screening plus usual care versus usual care alone from a Medicare perspective, distinguishing ED and non-ED diagnostic pathways. The analysis assumed some ED involvement is avoidable through screening, such that MCED-detected cancers have mortality similar to other non-ED detected cancers of the same type and stage. Cancer- and stage-specific rates of ED involvement and associated survival HRs were incorporated across all cancers using inputs informed by SEER-Medicare analyses. MCED test performance was based on published case-control data. Key outcomes included reductions in ED involvement and gains in LYs and QALYs.
RESULTS: In the usual care arm, 24.9% of cancer diagnoses occurred through ED involvement. MCED screening was projected to reduce EDs by 51%, with the largest reductions in later-stage disease (stage I: 17%; II: 36%; III: 61%; IV: 70%). Accounting for reduced ED involvement increased LYs gained by 50%, from 0.12 to 0.18 per person screened, and increased QALYs gained by 45%, from 0.09 to 0.13.
CONCLUSIONS: MCED screening may reduce ED involvement, particularly for later-stage disease and cancers without recommended screening, leading to substantial improvements in projected clinical outcomes. These findings underscore the importance of incorporating reductions in ED involvement in assessments of MCED screening.
METHODS: We extended a previously published cost-effectiveness model to compare annual MCED screening plus usual care versus usual care alone from a Medicare perspective, distinguishing ED and non-ED diagnostic pathways. The analysis assumed some ED involvement is avoidable through screening, such that MCED-detected cancers have mortality similar to other non-ED detected cancers of the same type and stage. Cancer- and stage-specific rates of ED involvement and associated survival HRs were incorporated across all cancers using inputs informed by SEER-Medicare analyses. MCED test performance was based on published case-control data. Key outcomes included reductions in ED involvement and gains in LYs and QALYs.
RESULTS: In the usual care arm, 24.9% of cancer diagnoses occurred through ED involvement. MCED screening was projected to reduce EDs by 51%, with the largest reductions in later-stage disease (stage I: 17%; II: 36%; III: 61%; IV: 70%). Accounting for reduced ED involvement increased LYs gained by 50%, from 0.12 to 0.18 per person screened, and increased QALYs gained by 45%, from 0.09 to 0.13.
CONCLUSIONS: MCED screening may reduce ED involvement, particularly for later-stage disease and cancers without recommended screening, leading to substantial improvements in projected clinical outcomes. These findings underscore the importance of incorporating reductions in ED involvement in assessments of MCED screening.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE139
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology