Commercially available noninvasive screening tests for colorectal cancer—the fecal immunochemical test (FIT) and the Cologuard multitarget stool DNA test—are equally effective for screening patients with early-stage colorectal cancer. However, FIT costs about one-fifth of the multitarget stool DNA test, according to findings from a new study presented by Rao et al at the 2022 Scientific Forum of the American College of Surgeons Clinical Congress.
The study looked at 117,519 individuals in the Highmark claims database who underwent screening for colorectal cancer in 2019. From that group, the researchers identified 91,297 individuals who underwent noninvasive screening with either FIT (n = 45,487) or the multitarget stool DNA test (n = 46,110) instead of having a routine colonoscopy.
I think a colorectal surgeon or any specialist who sees appropriate patients for colorectal cancer screening can use this data to provide recommendations of alternative screening tests to patients who primarily do not want to undergo [a] colonoscopy. We cannot only say it is appropriate from a guideline standpoint, but we're also reducing wasteful spending in health care by appropriately using FIT.— Pavan K. Rao, MD
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Key Findings
Among the study population that underwent colorectal cancer screening, 38.7% of patients had one of two commercially available FIT tests and 39.2% had the multitarget stool DNA test. Patients who were screened with either test presented with stage 0 to stage II colorectal cancer at similar rates: 59.5% for FIT and 63.2% for the multitarget stool DNA test (P = .77).
Patients within the Allegheny Health Network Oncology Registry diagnosed with colorectal cancer were matched to their claims data to determine disease stage. If the noninvasive test indicated signs of early disease, patients were then referred for additional testing to confirm the findings.
The total annual costs for the tests were $6.47 million—$1.1 million for FIT (about $24 per test) and $5.6 million for the multitarget stool DNA test (about $121 per test). Costs were calculated using Medicare reimbursement rates.
Observations on Study Results
"Despite national guidelines suggesting that FIT be used as the primary noninvasive screening modality, we found that on review of our insurer's claims data, a significant proportion of patients still receive a more expensive alternative test. There is substantial cost savings not only to our patients but to our health system with promoting appropriate use of noninvasive testing," said Pavan K. Rao, MD, a general surgery resident at Allegheny Health Network.
"When you look at the national data for which the guidelines put forward, they found no difference between the two tests at detecting adenoma [vs] colorectal malignancy … which again demonstrates the clinical equipoise maintained by switching to FIT," Dr. Rao said of the variation between the two tests.
Cost Savings Without Compromising Care
The researchers determined that transitioning all noninvasive colorectal cancer screening to FIT would result in $3.9 million annual savings in the study population.
"In the current state of health care, we are thinking ever more about efficiency and reduction in costs while maintaining patient outcomes, and not compromising the quality of care we provide," Dr. Rao said. "I think a colorectal surgeon or any specialist who sees appropriate patients for colorectal cancer screening can use this data to provide recommendations of alternative screening tests to patients who primarily do not want to undergo [a] colonoscopy. We cannot only say it is appropriate from a guideline standpoint, but we're also reducing wasteful spending in health care by appropriately using FIT."
What made this study unique was the methodology used to analyze the claims data, said study coauthor Casey J. Allen, MD, a surgical oncologist at Allegheny Health Network and an Assistant Professor of Surgery at the Drexel University College of Medicine. The researchers analyzed outcomes in the local health registry and then applied those outcomes to the claims database. "It's not just the cost of the [multitarget stool DNA] test kit or the cost of the FIT kit multiplied by the number of members in the health-care system," Dr. Allen said. "It's the full downstream costs depending on the rates of false-positive and false-negative tests, and how much it costs to obtain a colonoscopy when that occurs.” The researches noted that the cost of a colonoscopy in the database was $635.
These results supported previous studies out of Japan and the Netherlands that found FIT was more cost-effective than other types of noninvasive colorectal cancer screening tests.
The study followed guidelines updated in 2019 by the U.S. Preventive Services Task Force (USPSTF). Since the study, the guidelines were updated again in 2021.
Disclosure: For full disclosures of the study authors, visit facs.org.
