Study Reveals Higher Costs for Multitarget Stool DNA Tests Compared to FIT in Colorectal Cancer Screening

Recent research has indicated that multitarget stool DNA tests (MSDT) and next-generation multitarget stool DNA tests (N-G MSDT) incur significantly higher costs for the early detection of colorectal cancer (CRC) compared to traditional fecal immunochemical tests (FIT). The findings were published in the Annals of Internal Medicine, where researchers from the German Cancer Research Center in Heidelberg analyzed the economic implications of these screening methods.

The study assessed the costs associated with each screening method per early-detected case of advanced neoplasia and CRC. It was found that even if the costs of MSDT and N-G MSDT were reduced to less than 20% of their current levels, the expenses incurred per additional early-detected CRC case would still remain significantly higher than those associated with FIT-based screening.

To arrive at these conclusions, the researchers compared the diagnostic efficacy of Exact Sciences' Cologuard (MSDT) and Cologuard Plus (N-G MSDT) against a commercial FIT. They calculated the total costs of testing and follow-up colonoscopy, dividing these figures by the number of participants diagnosed with CRC or any advanced neoplasia. Their analysis revealed that, assuming a 60% follow-up colonoscopy uptake rate, the costs per detected advanced neoplasia case or early detected CRC case were approximately seven to nine times higher for MSDT and N-G MSDT compared to FIT.

Moreover, the research highlighted that the incremental costs for detecting one additional early CRC case through MSDT and N-G MSDT are about 40 and 30 times higher, respectively, than those for cases detected via FIT. When evaluating various scenarios based on different follow-up rates for colonoscopy, the costs for early detection escalated further. If the follow-up rate dropped to 30%, the cost to detect one additional CRC case could exceed $1.4 million for MSDT and $1.5 million for N-G MSDT. Conversely, even a higher follow-up rate of 90% did not substantially lower detection costs, which remained above $500,000 for both tests.

While MSDT and N-G MSDT offer enhanced sensitivity compared to FIT, the researchers noted that a similar level of sensitivity and specificity could be achieved with FIT at no added cost by simply adjusting the positivity threshold. This finding suggests that while newer testing options may have their advantages, they come with a financial burden that may not be justified when considering existing alternatives.

This research underscores the importance of evaluating not just the effectiveness of cancer screening tests but also their economic viability. As healthcare systems continue to grapple with the rising costs of cancer care, such studies are crucial for informing policy decisions regarding screening protocols and resource allocation.