Assessing the Cost-Effectiveness of Multi-cancer Early Detection Screening

In the general population, multi-cancer early detection (MCED) has been shown to be cost-effective. While individuals with personal and/or family history of cancer may opt for cancer screening at earlier ages than those without such history, the potential benefits of early detection must be balanced with potential harms, such as false-positives and increased costs; therefore, this study was conducted to estimate the cost-effectiveness of MCED testing in adults with personal and/or family cancer history in the United States.

A Markov model was developed to compare annual MCED testing plus standard-of-care (SoC) screening versus SoC alone and was adapted to individuals with personal and/or family cancer history. MCED testing of the general population aged 50-79 years was compared with SoC, while initiating MCED testing screening in individuals up to 10 years younger with personal and/or family cancer history was also compared with SoC. Using data from literature, incidence for individuals with family cancer history was adjusted; for those with personal cancer history, incidence and mortality were adjusted using data from the Surveillance, Epidemiology, and End Results (SEER) Program. Benefit-harm balance was assessed by comparing the number of cancers detected by MCED per false-positive stemming from MCED, while cost-effectiveness was measured as incremental cost per quality-adjusted life year (QALY). Costs of MCED testing were set to meet a willingness-to-pay threshold of $100,000 per QALY when screening the general population aged 50-79 years.

MCED screening resulted in a better ratio of cancers detected per false-positive at all ages in patients with family history, with >10% more cancers detected, and adding MCED from age 45 in the cohort with family history had a better incremental cost per QALY compared to adding MCED to the general population at age 50. Among those with personal history, more cancers were detected per false-positive at all ages compared to the general population cohort, with >44% more cancers detected. Those with personal history had a lower cost per QALY when starting age was decreased to 40 years ($96,286/QALY) compared to the general population cohort starting at age 50.

In comparison to the general population from 50 to 79 years, individuals with personal and/or family cancer history can achieve better ratios of cancers detected per false-positive when initiating MCED screening up to 10 years earlier. Additionally, this study found comparable or improved cost-effectiveness when initiating MCED screening up to 10 years earlier in individuals with personal and/or family cancer history.

Source:

Kansal A, Shaul A, Ye W, et al. Cost-effectiveness of a multi-cancer early detection test in individuals with a personal or family history of cancer. Presented at: 2022 Academy of Managed Care Pharmacy Nexus Annual Meeting; October 11-14, 2022; National Harbor, MD. Poster Z11.