Cost-effectiveness of a multicancer early detection test in the US

Abstract

Objectives: Multicancer early detection (MCED) testing could result in earlier cancer diagnosis, thereby improving survival and reducing treatment costs. This study evaluated the cost-effectiveness of MCED testing plus usual care (UC) screening while accounting for the impact of clinical uncertainty and population heterogeneity for an MCED test with broad coverage of solid cancer incidence.

Study design: Cost-effectiveness analysis of MCED testing plus UC vs UC alone in an adult population in the US.

Methods: A hybrid cohort-level model compared annual MCED testing plus UC with UC alone in detecting cancer among individuals aged 50 to 79 years over a lifetime horizon from a US payer perspective. Sensitivity and scenario analyses were conducted to explore the impact of key clinical uncertainties and population heterogeneity in valuing MCED, including differential survival by cell-free DNA detectability status, cancer progression rate, and how the test is likely to be implemented in clinical practice.

Results: Among 100,000 individuals, MCED testing plus UC shifted 7200 cancers to earlier stages at diagnosis compared with UC alone, resulting in an additional 0.14 quality-adjusted life-years (QALYs) and $5241 treatment cost savings per person screened and an incremental cost-effectiveness ratio (ICER) of $66,048/QALY gained at $949 test price. Among analyses of clinical uncertainties, differential survival had the greatest impact on cost-effectiveness. In probabilistic sensitivity analyses, MCED testing plus UC was cost-effective in all analyses with a maximum ICER of $91,092/QALY.

Conclusions: Under a range of likely clinical scenarios, MCED testing was estimated to be cost-effective, improving survival and reducing treatment costs.