Blood-based MRD test for cancer recurrence can generate cost savings in colorectal cancer treatment, finds study in JAMA Health Forum

June 3, 2024
Circulating tumor DNA (ctDNA) testing for minimal residual disease (MRD) can reduce costs by up to 21% across health plan populations when half of eligible patients with stage II colorectal cancer are tested for treatment decisions.

A blood test could help reduce costs for health plans by reliably identifying patients who might be able to safely forgo chemotherapy after surgery for stage II colorectal cancer, according to a study published in JAMA Health Forum, a member of the JAMA Network.  

Researchers from Haystack Oncology, a Quest Diagnostics company and developer of the Haystack MRD tumor-informed ctDNA MRD technology, City of Hope and the Walter and Eliza Hall Institute of Medical Research conducted the study.  

In June 2022, a randomized clinical trial (DYNAMIC) demonstrated that a tumor-informed ctDNA MRD test performed on patients with stage II colorectal cancer reduced the application of adjuvant chemotherapy (ACT) by nearly half (15% vs. 28%) without compromising recurrence-free survival. While many patients can safely forgo ACT, physicians cannot reliably identify these patients with conventional pathological and clinical metrics. This information could help reduce the administration of ACT, thus decreasing the risk of adverse events and the related costs ($44,022 to $65,792 per patient). Results from the DYNAMIC study demonstrate that post-surgical evaluation with an appropriate ctDNA MRD test can significantly improve the identification of patients that stand to benefit from ACT. 

The Haystack ctDNA MRD technology is a highly optimized version of the Safe-SeqS chemistry used in the DYNAMIC study. 

In the new analysis, hypothetical health plans with 1 million covered lives included 35 commercial health plan members and 102 Medicare Advantage members aged 75 years of age or younger with stage II colon cancer who were eligible for ctDNA MRD testing. The analysis compared standard clinical evaluation to a hypothetical treatment model in which 50% of patients are managed with tumor-informed ctDNA MRD testing. 

Among the study’s key findings: 

  • ctDNA MRD testing would reduce costs by 21% (1,068,040 vs. 846,356, a savings of $221,684 in total or $0.018 per member per month [PMPM]) for a commercial plan population and by 5% (2,550,029 vs. 2,433,309, a savings of $116,720 in total or $0.01 PMPM) for a Medicare Advantage plan population. Differences in cost savings between commercial and Medicare plans are related to differences in average age of plan members and associated clinical practice patterns. 

  • Using ctDNA MRD for greater than 50% of patients would produce even higher cost savings. 

  • The number-needed-to-test to avoid ACT use in one patient was estimated to be 4 in the commercial health plan population and 10 in the Medicare Advantage population. 

  • The budget-neutral cost for ctDNA testing was $16,202 for a commercial health plan and $5,793 for a Medicare Advantage payer. While the base-case model assumed 6 months of ACT, savings were also observed for a more conservative 3 months of therapy.