Multitarget stool DNA tests cost more than FIT for early colorectal cancer detection, study finds

A brief research report compared screening costs per early-detected colorectal cancer (CRC) case among fecal immunochemical tests (FIT), multitarget stool DNA tests (MSDT) and next-generation MSDTs (N-G MSDT).

The study found that screening costs per early-detected advanced neoplasia and CRC case are higher for MSDT-based and N-G MSDT–based screening than for FIT-based screening. The costs per additional early-detected CRC case would still be significantly higher than FIT-based screening even if MSDT and N-G MSDT test costs were lowered to less than 20% of their current costs.

The study is published in Annals of Internal Medicine.

Researchers from the German Cancer Research Center in Heidelberg, Germany analyzed results of two studies comparing the diagnostic performance of the MSDT (Exact Sciences’ Cologuard) and N-G MSDT (Exact Sciences’ Cologuard Plus) and a commercial FIT, costs per test reimbursed by Medicare, and uptake rates of colonoscopy after a positive result.

The researchers summed the test and follow-up colonoscopy costs and divided the costs by number of study participants with detected CRC or any advanced neoplasia. They also calculated costs per additional early-detected CRC case or any advanced neoplasia.

The researchers found that, assuming a 60% uptake of follow-up colonoscopy, screening costs per detected advanced neoplasia case or early detected CRC case are seven- to nine-fold higher for MSDT-based and N-G MSDT-based screening than for FIT-based screening.

Costs per additional early-detected CRC case compared with FIT-based screening are approximately 40 and 30 times higher, respectively, than costs for the FIT-detected CRC cases.

The researchers also conducted an analysis assuming lower (30%) and higher (90%) follow-up colonoscopy uptake and hypothetical lower costs per test for MSDT and N-G MSDT.

With the lower uptake rate of screening, the incremental costs for early detection of one additional CRC case compared with FIT-based screening would increase to more than $1.4 million for the MSDT and more than $1.5 million for the N-G MSDT.

With the higher uptake rate, the detection rates per CRC case would be somewhat lower, but the incremental costs for early detection of one additional CRC case would still be above $500,000 for both the MSDT and N-G MSDT.

The researchers note that although the MSDT and N-G MSDT have higher sensitivity compared to FIT, the same sensitivity and specificity could be achieved at no incremental cost by lowering the FIT positivity threshold.