DRAFT: Not for Citation
Undiscounted outcomes associated with the screening strategies are presented in Table 8A for the MISCAN model, Table 8B for the SimCRC model, and Table 8C for the CRC-SPIN model. Without screening we project that 53 to 60 out of every 1000 65-year old individuals will be diagnosed with CRC in their lifetimes. This induces approximately $3.0 to $4.0 million in lifetime direct medical costs ($57 to $71 thousand per CRC case). With screening and removal of adenomas that may have become cancer over time, many of these CRC cases can be prevented assuming 100% adherence to screening regiments; the reduction in the lifetime risk of CRC ranged from 32-49% with annual FOBT (Hemoccult II) screening to 53-85% with 10-year colonoscopy screening (reported ranges reflect differences in projections by model). Some of the benefit associated with the fecal-related tests is a result of the false-positive rate, which leads to individuals being placed on a colonoscopy schedule. In other words, some of the benefit of these tests can be attributed to the fact that a substantial number of individuals with false-positive test results subsequently undergo screening with 10-year colonoscopy. In the MISCAN model the combination of 5-yearly flexible sigmoidoscopy with an annual highly sensitive FOBT (Hemoccult SENSA or FIT) are the two most effective strategies in terms of life-years gained compared with no screening, saving 154 life-years per 1000 persons screened. In the SimCRC and CRC-SPIN models, 10-yearly colonoscopy is most effective, saving 171 and 185 life-years per 1000 persons screened, respectively. Five-yearly CT colonography with a 6mm referral threshold and the most optimistic test characteristics (i.e., DoD study) resulted in 2-7 fewer life-years gained per 1000 individuals compared with 10-yearly colonoscopy, with an increase in lifetime (undiscounted) costs of approximately $600,000-$700,000 per 1000.
Table 9 shows the total discounted costs, discounted life-years gained, and the incremental cost-effectiveness ratios for a cohort of 65-year-olds by screening strategy, including no screening, for each model (results for a cohort of 50-year-olds are presented in Appendix 4). Note that the incremental cost-effectiveness ratios were calculated using each CT colonography strategy in turn as they are not competing options. The models varied somewhat as to which tests were on the efficient frontier (i.e., were not ruled out by simple or extended dominance). Strategies on the efficient frontier are those strategies with an associated incremental cost-effectiveness ratio and are potentially cost-effective depending on the societal willingness to pay for a life-year gained. All three models showed the CT colonography strategies to be the most costly options. Figure 2 shows the plots of the discounted life-years gained (compared with no screening), the discounted lifetime direct medical costs (from the Medicare perspective), and the cost-efficient frontier, where each non-dominated strategy is compared with the next least expensive strategy. Hemoccult II was cost-saving compared with no screening for all models. This was the only cost-saving strategy in the MISCAN model. For SimCRC and CRC-SPIN, however, all non-CT colonography strategies were cost-saving compared with no screening. That CT colonography strategies were the most costly can be easily seen from Figure 2 since for all three modes the CT colonography strategies lie to the far right of all screening strategies.
At a cost per test of $488, none of the CT colonography strategies were on the efficient frontier (Figure 2). Table 10 shows the threshold CT colonography costs under the two base-case scenarios. Threshold analyses indicated that in order for the base-case 5-yearly CT colonography strategies with a 6mm referral threshold to be on the efficient frontier, a CT scan would need to cost between $108 and $205 (depending on the test characteristics and the simulation model used). The range of threshold costs required for CT colonography screening to be on the efficient frontier was wider when considering 10-yearly CTC strategies with a 6mm threshold, ranging from $103 to $371. Table 10 also presents threshold costs for CT colonography to reach the efficient frontier under different scenarios of the test characteristics for CT colonography (worst-case assumption and 2D reading from the DoD study). The threshold costs were much lower than the base-case values, while the 2D DoD analysis was more consistent with the base-case analysis, although the range was wider.
Table 10 also reports the secondary analyses where different criteria were used to calculate the CT scan cost thresholds. Note, that the primary analysis represents the theoretically correct analysis. The threshold costs tended to be slightly higher when compared with no screening and when compared with the strategy with the highest ACER. In order for the base-case CT colonography strategies (i.e., 5-yearly screening with a 6mm referral threshold) to have the same ACER compared with no screening as the colonoscopy strategy, a CT scan would have to cost between $179 and $237 (depending upon the CT colonography test characteristics and the model used). In only one case the threshold cost was greater than the base-case unit cost estimate of $488; this was the threshold cost that made 10-yearly CT colonography screening with a 6mm referral threshold cost-neutral compared with no screening and was true for only one model (Table 10). Figures 3-6 illustrate threshold cost values graphically.
The threshold costs associated with varying the test characteristics for CT colonography strategies with a 10 mm colonoscopy referral threshold are shown in Table 11. Threshold analyses indicated that in order for 5-yearly CT colonography with a 10mm referral threshold to be on the efficient frontier, a CT scan would need to cost in the range of $98 to $192 for primary 3D reads, $49 to $135 for mixed 2D and 3D reads, and $73 to $160 for primary 2D reads (depending on the test characteristics and the simulation model used). The ranges of threshold costs were wider when considering 10-yearly CT colonography strategies with a 10mm threshold, ranging from $71 to $238 for primary 3D reads, $3 to $167 for mixed 2D and 3D reads, and $72 to $175 for primary 2D reads. Using the secondary criteria to determine thresholds, the threshold costs tended to be slightly higher than the primary analysis (i.e., on the efficient frontier). In no case was the threshold cost greater than the base-case unit cost estimate of $488.
If individuals who would not be screened otherwise would get screened with CT colonography, its cost-effectiveness would improve. The threshold costs for the test to lie on the efficient frontier under varying adherence assumptions are shown in Table 12. With a 10% improvement in CT colonography screening adherence compared with other tests (i.e., 55% overall adherence), the CT colonography cost threshold for being on the efficient frontier increased to $293-$408. With a 25% improvement in CT colonography screening adherence compared with other tests (i.e., 62.5% overall adherence), the CT colonography cost threshold for being on the efficient frontier increased to $547-$694.
Table 13 contains the results of the threshold analysis from a modified societal perspective. From this perspective the threshold costs that result in a CT colonography strategy reaching the efficient frontier are $154-$336 for the 5-yearly testing with a 6 mm referral threshold and $166-$480 for 10-yearly testing with a 6 mm referral threshold. These thresholds costs are a bit higher than those from the payer perspective. The higher frequency of Hemoccult II and Hemoccult SENSA scenarios results in considerably higher additional time costs than with CT screening, allowing for higher per-test costs for the CT scan. The total threshold costs include co-payments and patient time costs. To obtain CMS reimbursement rates co-payments and patient time costs should be subtracted from the total threshold costs. Assuming no co-payments and patient time costs of $17 per hour yields CMS reimbursement rates of $26-$181 for 5-yearly CT colonography screening with a 6mm referral threshold and $11-$325 for 10-yearly CTC screening.
All analyses were conducted for the Medicare population aged 65 years and older assuming no prior CRC screening among this group. To assess the effect of this assumption, we evaluated the cost-effectiveness of the 15 screening strategies for a cohort of 50-year-olds, with screening starting at age 50. Results are presented in Appendix 4. The CT colonography strategies remained the most costly of the screening strategies considered. Threshold analyses indicated that in order for 5-yearly CT colonography with a 6mm referral threshold to be on the efficient frontier, a CT scan would need to cost between $72 and $179 (depending on the test characteristics and the simulation model used), which was lower than we found in the analysis of 65-year-old individuals. The range of threshold costs was wider when considering 10-yearly CT colonography strategies with a 6mm threshold, ranging from $15 to $220, which is also lower than the Medicare payer analysis.
Scenario | Costs ($) | Outcomes | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Screening | Follow-Up | Polyp Resection | Surveillance | Complications | CRC Treatment | Total Costs | LYG | SymDx CRC | ScnDx CRC | |
No screening | 0 | 0 | 0 | 0 | 0 | 4,030,647 | 4,030,647 | 0 | 57 | 0 |
HII | 45,577 | 207,470 | 86,984 | 418,620 | 15,647 | 2,927,696 | 3,701,995 | 116.5 | 18 | 21 |
HS | 31,762 | 370,237 | 125,488 | 693,037 | 26,573 | 2,501,443 | 3,748,541 | 142.8 | 12 | 20 |
FIT | 178,116 | 318,912 | 116,129 | 614,068 | 23,317 | 2,573,214 | 3,823,757 | 141.0 | 12 | 21 |
SIGB | 516,641 | 193,530 | 115,568 | 545,450 | 19,110 | 2,415,702 | 3,806,002 | 132.2 | 16 | 14 |
SIG | 378,703 | 268,592 | 124,815 | 633,967 | 23,143 | 2,371,694 | 3,800,914 | 135.4 | 15 | 15 |
HII + SIGB | 471,033 | 279,361 | 130,886 | 665,461 | 24,154 | 2,098,139 | 3,669,035 | 149.1 | 11 | 17 |
HII + SIG | 355,281 | 333,025 | 136,711 | 730,181 | 26,790 | 2,275,248 | 3,857,236 | 149.9 | 11 | 17 |
HS + SIGB | 344,285 | 398,694 | 145,073 | 819,404 | 30,834 | 2,016,539 | 3,754,829 | 154.1 | 10 | 17 |
HS + SIG | 262,997 | 422,676 | 147,776 | 854,913 | 32,091 | 2,208,379 | 3,928,832 | 154.1 | 10 | 17 |
FIT + SIGB | 507,549 | 356,996 | 140,678 | 765,688 | 28,504 | 2,229,174 | 4,028,589 | 154.3 | 10 | 18 |
FIT + SIG | 402,045 | 391,252 | 144,355 | 811,232 | 30,469 | 2,219,036 | 3,998,390 | 154.3 | 10 | 18 |
COL | 776,369 | 0 | 152,502 | 677,187 | 36,327 | 2,198,866 | 3,841,252 | 151.6 | 12 | 15 |
CTC DoD 3D 6mm 5y | 1,007,280 | 354,666 | 135,665 | 748,110 | 27,561 | 2,264,920 | 4,538,212 | 149.5 | 11 | 17 |
CTC NCTC 2D/3D 6mm 5y | 1,129,911 | 290,386 | 123,520 | 644,144 | 23,369 | 2,375,757 | 4,587,088 | 142.7 | 13 | 17 |
LYG = life-years gained compared with no screening; SymDx CRC = symptom-detected colorectal cancer; ScnDx CRC = screen-detected colorectal cancer.
Scenario | Costs ($) | Outcomes | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Screening | Follow-Up | Polyp Resection | Surveillance | Complications | CRC Treatment | Total Costs | LYG | SymDx CRC | ScnDx CRC | |
No screening | 0 | 0 | 0 | 0 | 0 | 3,540,411 | 3,540,411 | 0 | 60 | 0 |
HII | 74,558 | 189,224 | 63,882 | 251,236 | 11,119 | 2,213,526 | 2,803,544 | 113.9 | 14 | 21 |
HS | 121,839 | 359,983 | 100,870 | 409,826 | 20,408 | 1,636,905 | 2,649,832 | 150.7 | 8 | 18 |
FIT | 248,015 | 305,726 | 91,444 | 371,278 | 17,606 | 1,711,732 | 2,745,801 | 148.3 | 8 | 19 |
SIGB | 458,414 | 129,774 | 153,495 | 302,136 | 11,130 | 1,795,444 | 2,850,392 | 120.6 | 19 | 10 |
SIG | 452,330 | 218,999 | 82,962 | 355,829 | 15,267 | 1,684,643 | 2,810,029 | 128.0 | 16 | 10 |
HII + SIGB | 522,284 | 251,218 | 168,972 | 239,952 | 13,014 | 1,446,187 | 2,641,626 | 157.7 | 7 | 15 |
HII + SIG | 529,760 | 331,172 | 89,836 | 255,648 | 15,279 | 1,395,290 | 2,616,985 | 160.1 | 7 | 15 |
HS + SIGB | 437,692 | 388,531 | 171,293 | 417,676 | 21,751 | 1,255,331 | 2,692,275 | 169.3 | 6 | 14 |
HS + SIG | 444,054 | 442,437 | 114,584 | 431,707 | 23,361 | 1,231,886 | 2,688,030 | 170.2 | 5 | 13 |
FIT + SIGB | 628,080 | 342,482 | 171,280 | 366,098 | 18,916 | 1,278,827 | 2,805,683 | 168.9 | 6 | 14 |
FIT + SIG | 638,476 | 405,523 | 107,594 | 379,303 | 20,723 | 1,251,488 | 2,803,107 | 169.9 | 5 | 14 |
COL | 783,430 | 0 | 137,876 | 598,884 | 32,857 | 1,124,529 | 2,677,576 | 171.3 | 6 | 11 |
CTC DoD 3D 6mm 5y | 1,115,618 | 348,524 | 114,329 | 500,485 | 23,565 | 1,172,674 | 3,275,196 | 168.2 | 6 | 12 |
CTC NCTC 2D/3D 6mm 5y | 1,213,047 | 280,882 | 101,516 | 441,470 | 19,842 | 1,288,954 | 3,345,711 | 160.2 | 7 | 12 |
LYG = life-years gained compared with no screening; SymDx CRC = symptom-detected colorectal cancer; ScnDx CRC = screen-detected colorectal cancer.
Scenario | Costs ($) | Outcomes | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Screening | Follow-Up | Polyp Resection | Surveillance | Complications | CRC Treatment | Total Costs | LYG | SymDx CRC | ScnDx CRC | |
No screening | 0 | 0 | 0 | 0 | 0 | 2,999,824 | 2,999,824 | 0 | 53 | 0 |
HII | 80,263 | 169,980 | 50,324 | 200,706 | 10,036 | 1,663,309 | 2,174,619 | 114.5 | 17 | 12 |
HS | 135,166 | 353,732 | 83,847 | 337,414 | 19,782 | 1,057,232 | 1,987,173 | 155.1 | 7 | 11 |
FIT | 267,328 | 293,055 | 74,803 | 302,324 | 16,660 | 1,160,290 | 2,114,460 | 150.4 | 8 | 11 |
SIGB | 478,290 | 110,463 | 209,824 | 269,120 | 10,365 | 1,211,533 | 2,289,595 | 133.7 | 17 | 4 |
SIG | 474,358 | 206,889 | 72,375 | 311,882 | 14,770 | 1,079,869 | 2,160,144 | 142.2 | 14 | 5 |
HII + SIGB | 479,837 | 221,064 | 204,285 | 347,052 | 15,715 | 877,095 | 2,145,048 | 163.7 | 7 | 7 |
HII + SIG | 476,977 | 289,511 | 86,877 | 373,491 | 18,922 | 813,753 | 2,059,531 | 166.7 | 7 | 7 |
HS + SIGB | 420,636 | 374,095 | 189,459 | 415,934 | 22,787 | 692,561 | 2,115,471 | 175.9 | 5 | 7 |
HS + SIG | 425,961 | 404,518 | 100,708 | 426,792 | 24,437 | 666,213 | 2,048,629 | 176.8 | 4 | 7 |
FIT + SIGB | 581,132 | 320,807 | 194,795 | 394,441 | 20,268 | 729,944 | 2,241,386 | 174.4 | 5 | 7 |
FIT + SIG | 567,998 | 364,345 | 96,403 | 411,602 | 22,497 | 694,657 | 2,157,501 | 175.8 | 5 | 7 |
COL | 822,584 | 0 | 118,456 | 506,142 | 33,208 | 496,246 | 1,976,636 | 184.9 | 3 | 5 |
CTC DoD 3D 6mm 5y | 1,202,218 | 329,204 | 92,468 | 398,610 | 21,994 | 610,307 | 2,654,802 | 177.7 | 5 | 5 |
CTC NCTC 2D/3D 6mm 5y | 1,287,352 | 258,000 | 83,325 | 363,894 | 18,549 | 686,995 | 2,698,114 | 172.2 | 6 | 5 |
LYG = life-years gained compared with no screening; SymDx CRC = symptom-detected colorectal cancer; ScnDx CRC = screen-detected colorectal cancer.
Strategy | MISCAN | SimCRC | CRC-SPIN | ||||||
---|---|---|---|---|---|---|---|---|---|
Discounted Costs ($) | Discounted LYG | ICER ($) | Discounted Costs ($) | Discounted LYG | ICER ($) | Discounted Costs ($) | Discounted LYG | ICER ($) | |
No Screening | 2,714,556 | 0 | d | 2,367,514 | 0 | d | 1,976,803 | 0 | d |
HII | 2,631,879 | 65.7 | --- | 2,082,788 | 59.9 | d | 1,536,474 | 64.0 | d |
HS | 2,715,683 | 81.1 | 5,455 | 2,042,708 | 81.1 | --- | 1,482,449 | 87.3 | --- |
FIT | 2,777,228 | 80.1 | d | 2,116,618 | 79.8 | d | 1,574,679 | 84.7 | d |
SIGB | 2,823,217 | 75.0 | d | 2,168,782 | 65.2 | d | 1,716,321 | 75.8 | d |
SIG | 2,810,249 | 76.7 | d | 2,151,925 | 69.1 | d | 1,626,360 | 80.4 | d |
HII + SIGB | 2,790,651 | 84.9 | 19,381 | 2,085,889 | 85.7 | d | 1,656,317 | 92.9 | d |
HII + SIG | 2,839,118 | 85.4 | d | 2,072,929 | 87.0 | 5,147 | 1,590,434 | 94.5 | d |
HS + SIGB | 2,859,815 | 88.0 | 22,940 | 2,151,806 | 92.5 | d | 1,666,766 | 99.9 | d |
HS + SIG | 2,907,440 | 87.9 | d | 2,150,786 | 93.0 | 12,938 | 1,611,331 | 100.5 | d |
FIT + SIGB | 3,022,139 | 88.1 | d | 2,244,313 | 92.3 | d | 1,768,508 | 99.2 | d |
FIT + SIG | 2,990,860 | 88.1 | 988,660 | 2,244,650 | 92.8 | d | 1,699,373 | 99.9 | d |
COL | 2,906,228 | 86.7 | d | 2,173,712 | 93.8 | 27,737 | 1,600,155 | 105.5 | 6,465 |
CTC DoD 3D 6mm 5ya | 3,469,661 | 85.3 | d | 2,674,721 | 92.0 | d | 2,156,740 | 101.2 | d |
CTC NCTC 2D/3D 6mm 5ya | 3,489,238 | 81.3 | d | 2,706,113 | 87.2 | d | 2,172,677 | 98.0 | d |
--- indicates default strategy (i.e., the least costly and least effective non-dominated strategy).
LYG = life-years gained vs. no screening; ICER = incremental cost-effectiveness ratio; d = dominated.
a. The two CTC strategies are not competing options; they represent a range of estimates of CTC test characteristics. They are shown here together for comparison purposes only. The ICERs are assessed separately using each CTC strategy in turn.
a.The two CTC strategies are not competing options; they represent a range of estimates of CTC test characteristics. They are shown here together for comparison purposes only. The ICERs are assessed separately using each CTC strategy in turn.
a.The two CTC strategies are not competing options; they represent a range of estimates of CTC test characteristics. They are shown here together for comparison purposes only. The ICERs are assessed separately using each CTC strategy in turn.
a. The two CTC strategies are not competing options; they represent a range of estimates of CTC test characteristics. They are shown here together for comparison purposes only. The ICERs are assessed separately using each CTC strategy in turn.
CTC outcome | Base cases | Sensitivity analysisb | ||
---|---|---|---|---|
CTC DoD 3D 6mm | CTC NCTC 2D/3D 6mm | CTC WC 2D/3D 6mm | CTC DoD 2D 6mm | |
5-yearly CTC screening | ||||
On efficient frontier | 122, 196, 199 | 108, 183, 205 | 25, 83c, 173 | 98, 163c, 246 |
Cost-neutral vs. no screening | 76, 323, 398 | 105, 324, 398 | 38, 251, 336 | 112, 308, 393 |
Equal to highest ACER | 238, 258, 294 | 245, 268, 304 | 179, 197, 233 | 232, 261, 303 |
Equal to colonoscopy ACER | 179, 210, 221 | 194, 227, 237 | 127, 150, 167 | 188, 231, 235 |
10-yearly CTC screening | ||||
On efficient frontier | 103, 266, 352 | 108, 241c, 371 | 9, 115c, 123c | 89, 211c, 249c |
Cost-neutral vs. no screening | 114, 482, 599 | 143, 473, 599 | 68, 351, 472 | 147, 435, 582 |
Equal to highest ACER | 320, 396, 450 | 325, 398, 455 | 237, 285, 325 | 303, 372, 442 |
Equal to colonoscopy ACER | 244, 330, 348 | 258, 339, 356 | 175, 206, 248 | 246, 328, 337 |
ACER = average cost-effectiveness ratio compared with no screening (calculated using discounted costs and life-years gained).
a. MISCAN values in plain text; SimCRC values in italics; CRC-SPIN values in bold.
b. Go to Table 7 for the test characteristics used in these scenarios.
c. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.
DoD = Department of Defense Study (Pickhardt 2003, 2007a); NCTC = National CT Colonography study (Johnson 2008); WC = hypothetical worst-case scenario.
a. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.
DoD = Department of Defense Study (Pickhardt 2003, 2007a); J = Johnson study (Johnson 2007); NCTC = National CT Colonography study (Johnson 2008); WC = hypothetical worst-case scenario.
a. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.
DoD = Department of Defense Study (Pickhardt 2003, 2007a); NCTC = National CT Colonography study (Johnson 2008); WC = hypothetical worst-case scenario.
DoD = Department of Defense Study (Pickhardt 2003, 2007a); J = Johnson study (Johnson 2007); NCTC = National CT Colonography study (Johnson 2008); WC = hypothetical worst-case scenario.
CTC outcome | Sensitivity analysis scenarios with 10mm colonoscopy referral thresholds | |||||
---|---|---|---|---|---|---|
Primary 3D reads | 2D/3D reads | Primary 2D reads | ||||
CTC DoD 3D 10mm | CTC J 3D 10mm | CTC NCTC 2D/3D 10mm | CTC WC 2D/3D 10mm | CTC DoD 2D 10mm | CTC J 2D 10mm | |
5-yearly CTC screening | ||||||
On efficient frontier | 98, 132b, 192b | 71, 105b, 153b | 49, 90b, 135b | 10, 43b, 81b | 75, 110b, 160b | 73, 105b, 154b |
Cost-neutral vs. no screening | 118, 327, 329 | 106, 284, 297 | 68, 284, 309 | 43, 232, 265 | 110, 290, 301 | 107, 284, 296 |
Equal to highest ACER | 227, 246, 284 | 202, 216, 248 | 190, 216, 237 | 157, 172, 189 | 206, 221, 254 | 201, 215, 248 |
Equal to colonoscopy ACER | 178, 187, 259 | 151, 167, 228 | 142, 145, 210 | 96, 115, 166 | 155, 170, 233 | 150, 167, 229 |
10-yearly CTC screening | ||||||
On efficient frontier | 82, 163b, 238b | 71, 99b, 166b | 30, 104b, 167b | 3, 20b, 84b | 75, 108b, 175b | 72, 96b, 164b |
Cost-neutral vs. no screening | 139, 457, 487 | 127, 382, 420 | 88, 393, 440 | 61, 311, 356 | 131, 391, 428 | 128, 380, 417 |
Equal to highest ACER | 285, 350, 397 | 253, 285, 333 | 242, 299, 332 | 200, 215, 259 | 258, 293, 342 | 252, 282, 332 |
Equal to colonoscopy ACER | 231, 240, 364 | 176, 207, 306 | 184, 185, 298 | 100, 149, 229 | 184, 211, 314 | 173, 206, 306 |
ACER = average cost-effectiveness ratio compared with no screening (calculated using discounted costs and life-years gained).
a. MISCAN values in plain text; SimCRC values in italics; CRC-SPIN values in bold.
b. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.
CTC outcome | Base case (CTC DoD 3D 6mm 5y) |
Sensitivity Analysis on CTC Adherenceb | |
---|---|---|---|
Adherence 50% for all strategies | CTC adherence 55% | CTC adherence 62.5% | |
On efficient frontier | 122, 196, 199 | 293c, 360c, 408c | 547c, 668c, 694c |
Cost-neutral vs. no screening | 76, 323, 398 | 76, 323, 398 | 76, 323, 398 |
Equal to highest ACER | 238, 258, 294 | 238, 258, 294 | 238, 258, 294 |
Equal to colonoscopy ACER | 179, 210, 221 | 179, 210, 221 | 179, 210, 221 |
ACER = average cost-effectiveness ratio compared with no screening (calculated using discounted costs and life-years gained)
a. MISCAN values in plain text; SimCRC values in italics; CRC-SPIN values in bold.
b. Strategies other than CTC remain at 50% adherence.
c. CTC strategy is on the frontier with an incremental cost-effectiveness ratio (ICER) of $50,000 if the cost is at least this amount.
CTC outcome | Total threshold costs (includes co-payments and patient time costs) | CMS reimbursement rates (excludes co-payments and patient time costs) | ||
---|---|---|---|---|
CTC DoD 3D 6mm | CTC NCTC 2D/3D 6mm | CTC DoD 3D 6mm | CTC NCTC 2D/3D 6mm | |
5-yearly CTC screening | ||||
On efficient frontier | 181, 318, 332 | 154, 324, 336 | 26, 163, 177 | NT, 169, 181 |
Cost-neutral vs. no screening | NT, 288, 406 | 12, 321, 432 | NT, 133, 250 | NT, 166, 277 |
Equal to highest ACER | 294, 433,476 | 303, 445, 496 | 139, 278, 321 | 148, 290, 341 |
Equal to colonoscopy ACER | 215, 340, 347 | 234, 371, 372 | 60, 185, 191 | 79, 216, 217 |
10-yearly CTC screening | ||||
On efficient frontier | 166, 476, 480 | 176, 428, 474 | 11, 321, 325 | 21, 272, 318 |
Cost-neutral vs. no screening | NT, 471, 646 | 28, 494, 671 | NT, 315, 491 | NT, 339, 515 |
Equal to highest ACER | 398, 662, 747 | 405, 661, 768 | 243, 507, 591 | 250, 506, 613 |
Equal to colonoscopy ACER | 298, 548, 552 | 316, 562, 580 | 143, 393, 397 | 161, 406, 425 |
ACER = average cost-effectiveness ratio compared with no screening (calculated using discounted costs and life-years gained); NT = no threshold found (i.e., negative CTC test cost).
a. MISCAN values in plain text; SimCRC values in italics; CRC-SPIN values in bold.
b. CTC strategy is on the frontier as the least effective and least costly non-dominated strategy if the cost is at most this amount.