The fecal immunochemical test and the mt-sDNA test are equally effective for colorectal cancer screening

The fecal immunochemical test and the mt-sDNA test are equally effective for colorectal cancer screening

Commercially available noninvasive screening tests for colorectal cancer—a fecal immunochemical test (FIT) and the multi-target stool DNA test (mt-sDNA; or Cologuard®)—are equally effective for screening patients with early-stage colorectal cancer. However, a FIT costs about a fifth of the cost of a multi-target DNA test, according to new study results presented at the American College of Surgeons (ACS) Clinical Congress 2022 Scientific Forum.

Pavan K. Rao, MD, general surgery resident at Allegheny Health Network in Pittsburgh, Pennsylvania, presented study results on 117,519 people in the Highmark claims database who underwent colorectal screening in 2019. Highmark is an insurer of Blue Cross Blue Shield Association Mid-Atlantic States in four cases.

From this group, researchers identified 91,297 people who underwent noninvasive screening with either the fecal immunochemical test (FIT, n=45,487) or the DNA test (mt-sDNA, n=46,110) instead of a routine colonoscopy.

Key findings

• Of the study population who underwent colorectal screening, 45,487 (38.7 percent) had one of two commercially available FIT tests and 46,110 (39.2 percent) had the mt-sDNA test.

• Patients screened with either test demonstrated early stage 0 to II disease at similar rates: 59.5 percent for the FIT test and 63.2 percent for the mt-sDNA test (p=0.77).

• Patients in the Allegheny Health Network Oncology Registry diagnosed with colorectal cancer were matched with their claims data to determine cancer stage distribution. If the noninvasive test indicated signs of early disease, patients were referred for further testing to confirm the results.

• The total annual cost of the testing was $6.47 million; $1.1 million for a FIT or about $24 per test and $5.6 million for mt-sDNA or about $121 per test. Costs were calculated using Medicare reimbursement rates.

Observations on study results

The study followed 2016 US Preventive Services Task Force (USPSTF) guidelines and was updated in 2019. The guidelines have since been updated again in 2021.

Although national guidelines suggest using FIT as the primary non-invasive screening method, when reviewing our insurer's claims data, we found that a significant portion of patients still receive a more expensive alternative test. Promoting the appropriate use of non-invasive testing will result in significant cost savings not only for our patients, but also for our healthcare system.”

Dr. Pavan K. Rao, MD, general surgery resident, Allegheny Health Network in Pittsburgh, Pennsylvania

“There was no difference in clinical stage at diagnosis between the two tests, again demonstrating the clinical balance maintained by switching to FIT,” said Dr. Rao on the differences between the two tests.

He added: "If you look at the national data for which the guidelines were presented, they found no difference between the two tests in detecting adenomas and colorectal malignancies."

Cost savings without compromising care

The researchers concluded that switching all noninvasive colorectal cancer screenings to FIT would result in annual savings of $3.9 million in the study population.

“In the current healthcare climate, we are increasingly thinking about efficiency and cost reduction while maintaining patient outcomes and without compromising the quality of care we provide,” said Dr. Rao. "I think a colorectal surgeon or any specialist who is evaluating appropriate patients for colorectal cancer screening can use this data to make recommendations for alternative screening tests for patients who don't want to undergo a colonoscopy in the first place. We can't just say this is appropriate from a guideline perspective." , but we also reduce wasteful healthcare spending by using FIT appropriately.”

“What makes this study unique is the methodology used to analyze the claims data,” said study co-author Casey J. Allen, MD, a surgical oncologist at Allegheny Health Network and assistant professor at Drexel University College of Medicine in Pittsburgh. The researchers analyzed the results in the local health registry and then applied those results to the claims database. “It’s not just about the cost of the mt-sDNA test kit or the cost of the FIT kit multiplied by the number of members in the health system,” said Dr. Allen. "It's the total downstream cost depending on the rate of false positive and false negative tests and how much it costs to have a colonoscopy in that case. The cost of a screening colonoscopy was $635 in the database the researchers used."

These results support previous studies from Japan and the Netherlands that found FIT to be more cost-effective than other types of noninvasive colorectal screening tests.

Source:

American College of Surgeons

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