Comparative effectiveness and cost-effectiveness analysis of a urine metabolomics test vs. alternative colorectal cancer screening strategies
Despite the success of provincial screening programs, colorectal cancer (CRC) is still the third most common cancer in Canada and the second most common cause of cancer-related death. Fecal-based tests, such as fecal occult blood test (FOBT) and fecal immunochemical test (FIT), form the foundation of the provincial CRC screening programs in Canada. However, those tests have low sensitivity for CRC precursors, adenomatous polyps and have low adherence. This study evaluated the effectiveness and cost-effectiveness of a new urine metabolomic-based test (UMT) that detects adenomatous polyps and CRC.
A Markov model was designed using data from the literature and provincial healthcare databases for Canadian at average risk for CRC; calibration was performed against statistics data. Screening strategies included the following: FOBT every year, FIT every year, colonoscopy every 10 years, and UMT every year. The costs, quality adjusted life years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) for each strategy were estimated and compared.
Compared with no screening, a UMT strategy reduced CRC mortality by 49.9% and gained 0.15 life years per person at $42,325/life year gained in the base case analysis. FOBT reduced CRC mortality by 14.9% and gained 0.04 life years per person at $25,011/life year gained. FIT reduced CRC mortality by 35.8% and gained 0.11 life years per person at $25,500/life year while colonoscopy reduced CRC mortality by 24.7% and gained 0.08 life years per person at $50,875/life year.
A UMT strategy might be a cost-effective strategy when used in programmatic CRC screening programs.
KeywordsPolypDx Markov model Early detection of cancer QALY ICER
We would like to thank Richard N. Fedorak, Carole Chambers, and Grace Wong (Pharmacy Cancer Services, Alberta Health Services) for their contribution to this manuscript.
SB, LD, and DEL were responsible for the study conceptualization and design; SB, LD, KPI, DEL, EMK, HW, and LSW acquired and analyzed the data; statistical analyses of economic data were done by EMK and LSW; TXN and LD built the model and conducted formal analysis. All authors contributed to data interpretation and validation at each project stage. SB and LD led the preparation of the manuscript and all authors participated in its critical review and revision for important intellectual content. All authors approved the manuscript version for publishing and agreed to be accountable for all aspects of the work presented therein. Lastly, DC, LSW, and TXN acquired resources and provided supervision.
This study was funded by research grants from the Centre of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR), University of Alberta, Canada and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) at the National Institutes of Health (NIH), USA (grant number 1UG3EB024965-01).
Compliance with ethical standards
Conflict of interest
HW is cofounder and shareholder in Metabolomics Technologies Inc., while LD, KPI, and DC are employees of Metabolomics Technologies Inc.
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