FIT tests were more cost effective than blood tests for colorectal cancer screening
January 28, 2025
Source: Nascimento de Lima, P et al JAMA Network Open January 16, 2025. CRC= colorectal cancer. Negative number in last column means that this test increases total medical costs over patients’ lifetimes.
Colon cancer screening detects precancerous and early cancers, and this screening has led to an impressive decrease in colorectal cancer death rates in the US. However, most screening is done by colonoscopies, which require an (often unpleasant) colon cleanout and some anesthesia, so many people lose a day or even two days of work to get screened. Some cannot afford the time away from work, and some simply don’t want to go through this procedure. Many employers and health plans are looking for a way to bring the benefits of screening to this group of members.
Researchers used a microsimulation model to evaluate cost effectiveness of different approaches to screen this population, and published their results in JAMA Network Open. They created the model for a community health center using a simulation of 10 million people who turn 50 years old in 2025. The population in this simulation was majority Hispanic. The Hispanic populationhas a lower rate of colorectal cancer detection and death but higher rates of metastatic disease than non-Hispanic white people, so these data are not exactly applicable to other populations. The researchers considered likely test adherence when building their models, so not all who were assigned to a specific test would follow through.
They found that offering annual FIT tests (fecal immunochemical test) for colorectal cancer screening saved the most lives and saved the most money in medical care. This requires members to send a stool sample from the toilet, and no special diet. Cologuard requires sending an entire stool, and also requires no special diet. Blood tests for colon cancer screening (such as Guardant Shield) require no special diet and no handling of stool. These researchers found that the blood test screening increased total costs, and the other screening modalities led to lower lifetime costs. Most research has shown colorectal cancer screening to be cost-effective, but this simulation showed that this screening was cost-saving. Many of the projected savings would be realized later in life when people would be less likely to be covered by employer-sponsored health plans.
This graphic shows the decline in death rates from colorectal cancer since widespread screening was recommended.
Colorectal cancer Incidence and mortality rates
Source: Siegel, et al 2023. CA- Cancer Journal Incidence data is from 1930-2020, and mortality data is from 1976-2019, and is calculated from the SEER (Surveillance, Epidemiology, and End Results) database.
Implications for employers:
FIT testing continues to be the least expensive approach to colorectal cancer screening, and blood and stool DNA tests are far more expensive and in this simulation were less likely to save lives.
See this post from last Spring about colorectal cancer screening.
Tomorrow: Cancer deaths continue to decline