FIT-Fecal DNA Is Not Cost-effective Relative to Other Screening Strategies

This study is a cost-effectiveness modeling study (using 3 established models) of fecal immunochemical testing (FIT) with a fecal DNA test (FIT-fecal DNA) every 3 years versus annual guaiac fecal occult blood testing (FOBT) or FIT, flexible sigmoidoscopy every 5 years, flexible sigmoidoscopy every 10 years plus annual FOBT or FIT, and 10-year colonoscopy in 65-year-olds. At 100% adherence, the reduction of lifetime colorectal cancer risk was 46% with FIT-fecal DNA, 50% with annual FIT, and 73% with colonoscopy. FIT-fecal DNA every 3 years was cost-effective compared to no screening, but at the 2017 cost of $512 per test, it was the most costly strategy. FIT-fecal DNA every 3 years was substantially less cost-effective than nearly all other strategies and, in particular, less cost-effective than either annual FIT or colonoscopy every 10 years. At adherence rates 30% above other strategies, FIT-fecal DNA every 3 years was still not cost-effective compared to other strategies. Two models found that the cost of FIT-fecal DNA would need to drop to the range of $6 to $18 per test for FIT-fecal DNA every 3 years to be relatively cost-effective.

Naber SK, Knudsen KB, Zauber AG, et al. Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries. PLoS One 2019;14:e0220234. (https://doi.org/10.1371/journal.pone.0220234)