OBJECTIVES

Colorectal cancer (CRC) is the second most deadly cancer in the US. Early detection improves CRC outcomes. Multiple options are endorsed for CRC screening; however, adherence remains a challenge and underutilization of CRC screening has been documented among Medicaid enrollees (between 12.3–21.3% in some studies). The multi-target stool DNA (mt-sDNA) test, which includes patient and provider navigation support, may afford greater adherence to CRC screening in this population. We assessed cross-sectional adherence with mt-sDNA in a sample of patients with Medicaid.

METHODS

Aggregate data from Exact Sciences Laboratories LLC (ESL; Madison, WI) were retrospectively analyzed. Study participants included individuals ages 45+ years who were covered by Fee-For-Service (FFS) or Managed-Medicaid. The analysis cohort included patients with a valid mt-sDNA order between January 1 – December 31, 2018. Adherence was defined as successful completion of the test within 365 days of shipment date, and was assessed overall, and by patient- and provider-level factors.

RESULTS

In total, 26,132 participants were included in the analysis (61.2% women; mean age 57.7 years). Overall adherence was 51.3%. Adherence by plan was 54.6% in Managed-Medicaid, and 38.9% in FFS-Medicaid. Adherence by participant age was: 50% for 45-49 years, 51.5% for 50-64 years, 47.7% for 65-74 years, and 50.7% for 75-85 years. Participants with mt-sDNA tests ordered by gastroenterologists had higher adherence (60.4%) than those with orders placed by primary care clinicians (51.3%). Adherence was highest in the Mid-Atlantic (55.7%) and Pacific (51.5%) regions, and lowest in the New England (45.3%) and West South Central (44.4%) regions.

CONCLUSIONS

Data from this national sample of Medicaid-insured patients demonstrates relatively high cross-sectional adherence with mt-sDNA (51.3%). Stratification by provider revealed highest adherence with mt-sDNA tests ordered by gastroenterologists. The data herein support mt-sDNA testing as a navigation-supported, home-based option to improve CRC screening participation in Medicaid enrollees.