OBJECTIVES: Medicare beneficiaries account for more than half of new cancer cases in the US annually, with cancer the leading cause of death in this population. Cancer detection at earlier stages with MCED testing along with standard of care (SoC) could improve survival outcomes and lower treatment costs, but is expected to increase screening costs. This modeling study explores key drivers of the potential range of VBP for MCED testing in a Medicare population.

METHODS: A Markov model compared annual MCED plus SoC with SoC alone in a Medicare population (adults aged 65-79). Nineteen solid cancer groupings representing 80% of total cancer incidence were considered in the model. Model outcomes included costs, life-years (LYs) and quality adjusted life-years (QALYs) per person in the population over their lifetime, and were discounted 3% annually. MCED test activity was based on Klein et al (2021). SEER informed incidence and survival data by stage at detection, while SEER-Medicare data informed resource use and treatment costs. False positives caused additional workups and lower quality of life. VBP was estimated for willingness-to-pay (WTP) thresholds of $50,000/QALY and $150,000/QALY.

RESULTS: Testing with MCED increased LYs and QALYs by 0.10 and 0.10, respectively. The proportion of cancers detected at stage IV decreased from 21.6% to 12.5% and resulted in $2,006 less cancer-related treatment and diagnosis costs than SoC alone, excluding cost of MCED screening test. The VBP for MCED test ranged from $730/test to $1,771/test, at WTP thresholds of $50,000/QALY to $150,000/QALY respectively. Sensitivity analyses indicated that VBP in this population is sensitive to the number of clinically significant cancers detected, but relatively insensitive to changes in treatment cost and burden associated with false positives.

CONCLUSIONS: The addition of MCED testing to SoC in a Medicare population improves survival and lowers treatment costs as compared with SoC alone.