Potential Economic Value of Multi-cancer Early Detection Testing Under Differential Cost Trends for Cancer Screening and Management.

objectivesMulti-cancer early detection (MCED) tests aim to reduce the clinical and economic burden of cancer by detecting cases at earlier, more treatable stages. Recent trends indicate that the costs of cancer management are escalating, while screening costs have remained relatively stable over the past decade. This study evaluated the impact of these differing cost trends on the cost-effectiveness and net cost of MCED testing in the United States (US).

methodsA hybrid state-transition and decision-tree model was adapted for a lifetime analysis from commercial insurance and Medicare perspectives. Base-case treatment costs were derived from a Surveillance, Epidemiology, and End Results (SEER)-Medicare database study, and MCED test prices were set at $949 or $712 (25% reduction). Historical annual growth rates ranging from - 5 to 10% were then applied to management and screening costs. Contour plots were used to depict the results from these cost growth scenarios. MCED test performance was informed based on results from a case-control study.

resultsAcross perspectives, the incremental cost-effectiveness ratio (ICER) of MCED was between $50,000 and $100,000/quality-adjusted life year (QALY) with no cost growth. In the commercial insurance perspective, MCED was found to gain QALYs and lower spending when the growth rate of cancer management costs exceeded 2-4% with no MCED cost growth. The ICER exceeded $150,000/QALY if the growth rate of MCED costs exceeded 4-6% with no cancer management cost growth. In Medicare, the same thresholds were reached with management growth rates of 7-8% and screening growth rates > 7%, respectively. Cost neutrality was achieved within 5-10 years when cancer management growth rates significantly exceeded MCED cost growth, but was not reached within 30 years if MCED cost growth rates exceed those of cancer management. Results were robust across conducted scenario and sensitivity analyses.

conclusionsEarly detection with MCED may help mitigate rising cancer management costs, yielding improved cost-effectiveness and, in some scenarios, a path to cost neutrality.