The Potential Value-Based Price of a Multi-Cancer Early Detection Genomic Blood Test to Complement Current Single Cancer Screening in the USA

Ali Tafazzoli (), Scott D. Ramsey, Alissa Shaul, Ameya Chavan, Weicheng Ye, Anuraag R. Kansal, Josh Ofman and A. Mark Fendrick
Additional contact information
Ali Tafazzoli: GRAIL LLC, a subsidiary of Illumina Inc.
Scott D. Ramsey: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center
Alissa Shaul: Evidera Inc.
Ameya Chavan: Evidera Inc.
Weicheng Ye: Evidera Inc.
Anuraag R. Kansal: GRAIL LLC, a subsidiary of Illumina Inc.
Josh Ofman: GRAIL LLC, a subsidiary of Illumina Inc.
A. Mark Fendrick: University of Michigan

PharmacoEconomics, 2022, vol. 40, issue 11, No 7, 1107-1117

Abstract: Abstract Background Multi-cancer early detection (MCED) testing could increase detection of cancer at early stages, when survival outcomes are better and treatment costs are lower, but is expected to increase screening costs. This study modeled an MCED test for 19 solid cancers in a US population and estimated the potential value-based price (the maximum price to meet a given willingness to pay) of the MCED test plus current single cancer screening (usual care) compared to usual care alone from a third-party payer perspective over a lifetime horizon. Methods A hybrid cohort-level state-transition and decision-tree model was developed to estimate the clinical and economic outcomes of annual MCED testing between age 50 and 79 years. The impact on time and stage of diagnosis was computed using an interception modeling approach, with the consequences of cancer modeled based on stage at diagnosis. The model parameters were mainly sourced from the literature, including a published case-control study to inform MCED test performance. All costs were inflated to 2021 US dollars. Results Multi-cancer early detection testing shifted cancer diagnoses to earlier stages, with a 53% reduction in stage IV cancer diagnoses, resulting in longer overall survival compared with usual care. Addition of MCED decreased per cancer treatment costs by $5421 and resulted in a gain of 0.13 and 0.38 quality-adjusted life-years across all individuals in the screening program and those diagnosed with cancer, respectively. At a willingness-to-pay threshold of $100,000 per quality-adjusted life-year gained, the potential value-based price of an MCED test was estimated at $1196. The projected survival of individuals diagnosed with cancer and the number of cancers detected at an earlier stage by MCED had the greatest impact on outcomes. Conclusions An MCED test with high specificity would potentially improve long-term health outcomes and reduce cancer treatment costs, resulting in a value-based price of $1196 at a $100,000/quality-adjusted life-year willingness-to-pay threshold.

Date: 2022
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DOI: 10.1007/s40273-022-01181-3

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