Less expensive non-invasive testing is an effective alternative to colorectal cancer screening

Key content

• National guidelines recommend that fecal immunochemical testing (FIT) be the primary non-invasive screening modality for early-stage colorectal cancer, but a significant proportion of patients still undergo a more expensive alternative test called Cologuard?
  。

• Data from national screening guidelines show no difference
  between the two tests in detecting adenomas and colorectal malignancies.
  

• These results are consistent with previous studies in Japan and the Netherlands, which concluded that FIT is an appropriate screening modality and more cost-effective than other types of non-invasive
  colorectal screening tests.
  

Commercial colorectal cancer non-invasive screening tests – fecal immunochemistry test (FIT) and multi-target fecal DNA test (mt-sDNA; or Cologuard?), which is equally effective
in screening patients with early-stage colorectal cancer.
However, according to the new findings presented at the 2022 American College of Surgeons (ACS) Clinical Congress Scientific Forum, FIT costs about one-fifth
the cost of multi-target DNA testing.

Pavan K.
Rao, MD, a general surgery resident at the Allegheny Health Network in Pittsburgh, Pennsylvania, presented the findings of the Highmark claims database of 117519 people
screened for colorectal cancer in 2019.
Highmark is the Blue Cross Blue Shield Society's insurance company
in four states in the Mid-Atlantic.

In this group, the researchers identified 91,297 people who underwent non-invasive screening for fecal immunochemical testing (FIT, n=45,487) or DNA testing (mt-sDNA, n=46,110) instead of routine colonoscopy
.

Important findings

• Of the study population undergoing colorectal screening, 45,487 (38.
  7%) underwent one of two commercially available FIT tests, and 46,110 (39.
  2%) underwent mt-sDNA testing
  .
  

• Patients who received either test developed early-stage disease, from grade 0 to II, with similar incidence: 59.
  5% in the FIT group and 63.
  2% in the mt-sDNA group (p=0.
  77).
  
  

• Patients diagnosed with colorectal cancer at the Allegheny Health Network tumor registry were matched with their claim data to determine the distribution
  of cancer stages.
  If a non-invasive test shows signs of early disease, the patient is referred for additional tests to confirm the results
  .
  

• The total annual cost of these tests ranged from $6.
  47 million to $1.
  1 million, with FIT being about $24 per test and mt-sDNA being $5.
  6 million or about $121 per test
  .
  Costs are calculated based on the reimbursement rate of medical insurance
  .
  

Observation of the results of the study

The study followed guidelines issued by the U.
S.
Preventive Services Task Force (USPSTF) in 2016 and updated
in 2019.
The guidelines have since been updated
again in 2021.
¹  

"Although national guidelines recommend FIT as the primary non-invasive screening modality, we found that a significant proportion of patients still received more expensive alternative tests
when reviewing claims data from our insurers.
By promoting the appropriate use of non-invasive testing, significant cost savings are achieved not only for our patients, but also for our health system," said
Dr.
Rao.

"There was no difference between the two tests in the clinical phase at the time of diagnosis, which once again demonstrates the clinical balance maintained after switching to FIT," Dr.
Rao said
of the differences between the two tests.

"When you look at the national data presented by the guidelines, they find no difference
between the two tests used to detect adenomas and colorectal malignancies," he added.
² 

Save costs without compromising care

The researchers determined that transferring all non-invasive colorectal cancer screening to FIT would save the study population $3.
9 million
annually.

"In the current state of healthcare, we are thinking more about efficiency and reducing costs while maintaining patient outcomes without compromising the quality of care we provide," Dr.
Rao said
.
"I think colorectal surgeons or any specialist who sees a suitable colorectal cancer screening patient can use this data to recommend
alternative screening tests for patients who primarily do not want to undergo colonoscopy.
" We can't just say it's appropriate from a guideline perspective, but we've also reduced wasteful spending
in healthcare through the proper use of FITs.
”

Study co-author Casey J.
Allen, M.
D.
, said what makes the study unique is the method
used to analyze claims data.
Casey J.
Allen is a surgical oncologist at the Allegheny Health Network and an assistant professor
at Drexel University School of Medicine in Pittsburgh.
The researchers analyzed the results from the local health registry and then applied those results to a claims database
.
"It's not just the cost of mt-sDNA test kits or FIT kits multiplied by the number of members of the healthcare system," Dr.
Allen said
.
"That's the whole downstream cost, depending on the ratio of false positive and false negative tests, and the cost of
doing a colonoscopy in this case.
" In the database used by the researchers, a colonoscopy screening cost $
635.

These results support previous Japanese ^studies3 and the ^Netherlands4 which found FIT to be more cost-effective than other types of non-invasive
colorectal screening tests.

Study co-authors are Samantha Falls, DO, Stacey Shipley, BA and Katie Farah, MD of the Alllegheny Health Network in Wexford, Pennsylvania; Patrick L.
Wagner, MD, FACS, David L.
Bartlett, MD, FACS, and Sricharan Chalikonda, MD, MHA, FACS
.