LAUSR

BACKGROUND There is an increasing usage of non-invasive screening modalities for colorectal cancer (CRC), primarily the fecal immunochemical test (FIT) and multi-target stool DNA test (mt-sDNA; Cologuard® [CG]). The aim of this study was to determine the comprehensive, long-term cost implications of these non-invasive screening modalities. STUDY DESIGN Utilizing a national insurer-based administrative dataset, patients screened for CRC from January 1, 2019 to December 31, 2019 were analyzed. A hierarchical logic system was used to determine the primary screening modality for each patient. The total annual costs in US dollars ($) were extrapolated using number of patients screened, costs per test, screening intervals, and costs incurred from false results. Patients within our tumor registry diagnosed with CRC were matched to their claims data, and cancer stage distribution was compared. RESULTS Of 119,334 members who underwent non-invasive screening, 38.1% underwent screening with FIT and 40.0% with CG. The combined annual cost for these two screening modalities was $13.7 million. By transitioning to FIT alone for all non-invasive screening, the total annual cost would decrease to $7.9 million, resulting in a savings of approximately $5.8 million per year. Additionally, by combining data from the network cancer registry and insurer-based claims dataset, we were able to match 533 individuals who underwent screening and were later diagnosed with CRC. The rate of early-stage (stage 0-II) disease was found to be similar between those screened with FIT and CG (59.5% FIT vs. 63.2% CG; p=0.77). CONCLUSION The adoption of FIT as the primary non-invasive CRC screening method has the potential to generate significant cost savings, and therefore, carries significant value implications for a large population health system.