Cost-effectiveness of Colorectal Cancer Screening Tests: Reply

Comments were made by Limburg on the article by Rui and colleagues (1). This article is the first study to compare the cost-effectiveness of three novel colorectal cancer screening tests multitarget stool RNA (mt-sRNA), multitarget stool DNA (mt-sDNA) 2.0, and cell-free DNA (cfDNA) and all recommended screening strategies. The study concluded that all screening strategies were cost-effective compared with no screening. Every-10-year colonoscopy was the preferred cost-effective strategy under perfect adherence, whereas every-3-year mt-sRNA was the preferred option under test-specific adherence.In the process of conducting this study, the authors complied with guidelines of good research practices for modeling. Models synthesize evidence on health consequences and costs from multiple sources, such as clinical trials, observational studies, and peer-reviewed published findings (2, 3). Limburg’s comments referred to the study methodology. The authors, therefore, performed a self-assessment on the methodologic quality using the latest CHEERS checklist. The CHEERS checklist comprises 28 items across six categories: title, abstract, methods, results, discussion, and other relevant information (4). The quality assessment found that the published study fulfilled 25 of 28 items (89%) and is graded as excellent (scored ≥85%; ref. 5).Refer to comments on screening test-specific performance parameters; all parameters applied were sourced from peer-reviewed publications cited, either from the main text or supplementary materials of cited references. The parameters were defined consistently across tests. The details of data location in cited references and definitions applied are shown in Table 1.Model inputs in the present study were searched in PubMed, Embase, and Web of Science for peer-reviewed published literature. All base case values in health economic modeling are subject to uncertainties, and the uncertainties were examined by sensitivity analyses. Sensitivity analyses in the present study demonstrated that performance estimates of mt-sDNA 2.0 and mt-sRNA were influential factors in the cost-effectiveness results. The performance parameters in the FDA datasets are in line with estimates (referenced from published literature) used in the present study. If the FDA datasets were applied, it is also likely that the performance estimates would be influential factors.The term “real-world” adherence was applied to a nonperfect adherence scenario in the present study to evaluate the outcomes when adherence was <100% in all tests. The model inputs of adherence applied in the nonperfect adherence for mt-sDNA 2.0 and mt-sRNA were not yet reported and were therefore assumed to be the same as the marketed stool test mt-sDNA (with similar features), and the assumption was also examined by sensitivity analysis.No disclosures were reported.