OBJECTIVES : MCED testing could increase detection of cancer at early stages when survival outcomes are better and treatment costs are lower, but is expected to increase screening costs. This modeling study explores key drivers of the potential range of VBP for a multi-cancer test in a US population.

METHODS : A Markov model was developed to compare annual MCED plus standard of care (SoC) screening with SoC alone in US adults 50-79 years of age. The model included 19 solid cancer groupings representing 80% of total cancer incidence in this population. SEER data informed incidence and survival by stage at detection. SEER-Medicare linked data informed resource use with a 2.34x multiplier for commercial costs. MCED test performance was based on data from Klein et al (2021). The model estimated costs, life-years (LYs) and quality adjusted life-years (QALYs) over patients’ lifetime. False positives resulted in additional diagnostic workups and reduced quality of life. VBP was estimated for willingness-to-pay (WTP) thresholds of $50,000/QALY and $150,000/QALY. All costs and outcomes were discounted at 3% annually.

RESULTS : MCED reduced the proportion of cancers detected at stage IV to 10.7% from 20.4% and resulted in 0.18 more LYs, 0.17 more QALYs, and $5,397 less cancer-related treatment and diagnosis costs than SoC alone, excluding cost of the MCED screening test. At a WTP of $50,000/QALY, the VBP for the MCED test is $938/test, while at a WTP of $150,000/QALY, the VBP reaches $2,089/QALY. VBP is almost exactly proportional to the number of detected cancers per round of testing and thus changes linearly with overall cancer incidence or test sensitivity. Changes in treatment cost parameters and the impact of false positives have small impacts on VBP.

CONCLUSIONS : Maximizing cancer cases detected with a low false positive rate is the most significant driver of impact of MCED testing and, correspondingly, the VBP.