OBJECTIVES : Screening is essential to the prevention, early detection, and successful treatment of colorectal cancer (CRC). Providing options, including non-invasive modalities increases uptake of CRC screening. In order to maximize the benefit of screening, stakeholders must consider the probability that eligible patients will or will not screen. With the aim of examining the clinical and economic consequences of varying adherence levels, a budget impact model was developed from the payer and integrated delivery network (IDN) perspectives.

METHODS : Over a 10-year time horizon, mt-sDNA utilization increased from 6% to 28% among those screened by mt-sDNA, FIT and colonoscopy. The payer perspective included direct medical costs, such as stool-based tests, procedures, adverse events, and CRC treatment. In addition to CRC screening program costs, the IDN perspective also included all the aforementioned costs, with the exception of stool-based tests. Worst- and best-case adherence scenarios based on published estimates were simulated. For mt-sDNA, FIT, and colonoscopy, initial screening uptake ranged from 67.5%-71.1%, 48%-64.7%, and 38%-64%, whereas repeat adherence ranged from 54%-86.1% for stool-based screening and from 38%-64% for colonoscopy. Follow-up diagnostic colonoscopy adherence for non-invasive screening ranged from 55.6%-98.6%.

RESULTS : With a hypothetical population of 1 million members and an assumed screening eligible population of ages 50-75 at average risk for CRC, best- and worst-case adherence scenarios yielded approximately 11,000 and 19,000 fewer colonoscopies compared to the status quo. The payer savings ranged from $3M-$6M with $0.02-$0.05 per-member-per-month (PMPM) and the IDN incurred savings from $16M-$31M with $0.13-$0.26 PMPM for the best- and worst-case compliance adherence scenarios.

CONCLUSIONS : Due to the decrease in screening and surveillance colonoscopies as well as related adverse events, increased mt-sDNA use may lead to significant averted costs for payers and IDNs. Although increased adherence decreases aggregate averted costs, savings may persist with increased mt-sDNA use.