Economic Impact of Incorporating a Fecal Bacterial Signature to Optimize FIT-Based Colorectal Cancer Screening in Spain
Author(s)
Sandra Taboada-López, MSc1, Mireia Sánchez-Vizcaino1, MSc1, Paula Soriano-Nogales, MSc1, Lia Oliver, PhD1, Mariona Serra-Pagès, PhD1, Sara Ramió-Pujol, PhD1, Laura Baldo, Prof2, Joan Brunet, Prof3.
1GoodGut, Girona, Spain, 2University of Barcelona, Barcelona, Spain, 3Institut Català d'Oncologia, Girona, Spain.
1GoodGut, Girona, Spain, 2University of Barcelona, Barcelona, Spain, 3Institut Català d'Oncologia, Girona, Spain.
OBJECTIVES: Colorectal cancer (CRC) screening programs are essential for early detection and mortality reduction. However, the fecal immunochemical test (FIT) has a high false-positive (FP) rate, leading to unnecessary colonoscopies and substantial healthcare costs. A previously validated fecal bacterial signature has shown the potential to improve FIT specificity by reducing FP in multiple studies. This study evaluated the one-year economic impact of incorporating this bacterial signature into the CRC screening program in Spain.
METHODS: A comparative cost analysis was conducted to evaluate two strategies: (1) FIT-positive (≥20 µgHb/g) followed by colonoscopy, and (2) FIT-positive followed by the bacterial signature, with colonoscopy indicated only if both tests are positive. A cohort of individuals aged 50-69 years in Spain in 2024 was simulated, incorporating direct healthcare ressources and costs based on current epidemiological and clinical data. An interactive web-based tool was developed to enable real-time parameter customization for regional planning (https://cma-raidcrc-screen.shinyapps.io/cma_interface/).
RESULTS: In 2024, Spain’s target screening population was 13,620,780, of which 2,457,264 completed a valid FIT, reflecting 42% coverage and 42% participation rates. Considering a 5.73% FIT positivity rate, 140,801 individuals would be referred to colonoscopy, of whom 95,590 (67.89%) would not have significant findings and would be considered as FP. The bacterial signature reduced the performed colonoscopies to 68,638, a 28.19% reduction, decreasing unnecessary procedures and associated costs. The FIT+colonoscopy strategy cost was €142M, with 46.77% corresponding to costs from unnecessary procedures. Incorporating the bacterial signature reduced costs to €130M, saving €1.87M in primary care, €10.02M in colonoscopy-related costs, and €6.17M in secondary care. The €6.34M investment for the bacterial signature was offset by €17.72M in total savings, yielding €11.38M net savings (€-4.63 per participant).
CONCLUSIONS: Incorporating a validated fecal bacterial signature into FIT-based CRC screening improves healthcare resource utilization and reduces unnecessary procedures and its associated costs within Spain’s healthcare system.
METHODS: A comparative cost analysis was conducted to evaluate two strategies: (1) FIT-positive (≥20 µgHb/g) followed by colonoscopy, and (2) FIT-positive followed by the bacterial signature, with colonoscopy indicated only if both tests are positive. A cohort of individuals aged 50-69 years in Spain in 2024 was simulated, incorporating direct healthcare ressources and costs based on current epidemiological and clinical data. An interactive web-based tool was developed to enable real-time parameter customization for regional planning (https://cma-raidcrc-screen.shinyapps.io/cma_interface/).
RESULTS: In 2024, Spain’s target screening population was 13,620,780, of which 2,457,264 completed a valid FIT, reflecting 42% coverage and 42% participation rates. Considering a 5.73% FIT positivity rate, 140,801 individuals would be referred to colonoscopy, of whom 95,590 (67.89%) would not have significant findings and would be considered as FP. The bacterial signature reduced the performed colonoscopies to 68,638, a 28.19% reduction, decreasing unnecessary procedures and associated costs. The FIT+colonoscopy strategy cost was €142M, with 46.77% corresponding to costs from unnecessary procedures. Incorporating the bacterial signature reduced costs to €130M, saving €1.87M in primary care, €10.02M in colonoscopy-related costs, and €6.17M in secondary care. The €6.34M investment for the bacterial signature was offset by €17.72M in total savings, yielding €11.38M net savings (€-4.63 per participant).
CONCLUSIONS: Incorporating a validated fecal bacterial signature into FIT-based CRC screening improves healthcare resource utilization and reduces unnecessary procedures and its associated costs within Spain’s healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE399
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
Gastrointestinal Disorders, Oncology