Cost Considerations for Colorectal Cancer Screening: Examining the Data

Cost Considerations for Colorectal Cancer Screening: Examining the Data

A study published in March 2025 in Cancer Epidemiology, Biomarkers & Prevention offers important insights for the future of colorectal cancer (CRC) screening, particularly in how the cost-effectiveness of new noninvasive tests could reshape current practices. Here’s an overview of the research.

The Study’s Design
Using a simulated model of 100,000 average-risk 45-year-old adults, the research compared three novel screening options—multitarget stool RNA (mt-sRNA), multitarget stool DNA 2.0, and cell-free DNA tests—against guideline-recommended methods like colonoscopy, fecal immunochemical testing, and stool DNA testing.

The study evaluated each strategy's cost-effectiveness, measuring outcomes in terms of quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the perspective of U.S. healthcare payers.

The Study’s Results
Looking at the findings, the analysis confirmed that all screening methods reduced CRC incidence and mortality compared to no screening, reinforcing the critical role of routine screening in cancer prevention.

When assuming perfect adherence, colonoscopy every 10 years remains the most cost-effective option. However, the study acknowledged that real-world adherence to invasive tests is often less than ideal.

Factors such as test cost, sensitivity, CRC progression rates, and adherence levels greatly influenced which strategies were most cost-effective. Under realistic adherence assumptions, mt-sRNA testing every three years had the highest probability of being cost effective at 37.6 percent with an ICER of $95,250/QALY: well within the standard willingness-to-pay threshold.

The Study’s Implications
These findings have the potential to shift the CRC screening landscape, particularly because they emphasize an important message: patient adherence significantly impacts the success of any screening strategy. While colonoscopy is clinically effective, its invasive nature can deter patients. Noninvasive options like mt-sRNA, which are easier to complete and may see better uptake, could offer a practical and economically viable alternative, especially in underserved or hesitant populations.

For healthcare educators and public health professionals, this research underscores the importance of not only promoting screening but also offering options that patients are more likely to use. As healthcare systems aim to reduce CRC burden, integrating novel, patient-friendly, noninvasive tests like mt-sRNA could improve screening rates, reduce disparities, and save lives while maintaining cost-effectiveness.

Reference:

1. Rui M, Wang Y, You JHS. Novel noninvasive tests for colorectal cancer screening – a cost-effectiveness analysis. Cancer Epidemiology, Biomarkers & Prevention. Published online March 12, 2025:OF1-OF11.