Clinical, social, and economic impacts of colorectal cancer screening with the multi-target stool-DNA test: 10-year experience - a simulated study

IntroductionIn the United States, colorectal cancer (CRC) remains a substantial public health challenge, with approximately 150,000 new cases diagnosed annually. Guidelines from organizations such as the United States Preventive Services Task Force (USPSTF) recommend several screening strategies, including endoscopic, radiologic, and stool-based options such as the multi-target stool DNA (mt-sDNA) test. In this analysis, we analyzed the estimated clinical, social, and economic impacts of mt-sDNA screening over the inaugural 10-year period for test availability. MethodsTo assess the effectiveness of CRC screenings with the mt-sDNA test, published rates of advanced precancerous lesions (APL) and cancer prevalence by stage, as well as the transition rate of APL to CRC for the average-risk population in the US were used for a simulated population. The mt-sDNA tests sensitivity and specificity for APL and CRC were derived from previously published data. To assess the economic impact of screening with mt-sDNA compared to colonoscopy, we utilized data from literature regarding the time and resources required to prepare and complete each test. Furthermore, the costs of treatment according to the stage of colorectal cancer are considered, to show the value of CRC prevention and early detection. ResultsOur analysis indicates that mt-sDNA screening detected an estimated 98,000 cases of CRC and 525,000 individuals were found to have APLs, precursors to CRC. When using 10-year survival rate from CRC, it is estimated that the mt-sDNA test led to more than 34,000 patients surviving due to earlier intervention compared to no screening. Furthermore, the mt-sDNA test demonstrated approximately $22.3 billion cost savings compared to no screening, including an estimated $9.7 billion in cancer treatment costs through early CRC detection and an additional $12.6 billion resulting from cancer prevention through APL detection and management. ConclusionClinical availability, adoption, and growth of stool-based CRC screening have significantly increased overall screening rates in the US. It is estimated that mt-sDNA utilization will continue to grow, providing a home-based CRC screening solution for millions of screen-eligible US adults over the next decade and beyond.