The health economic impact of varying levels of adherence to colorectal screening on providers and payers

Figures & data

Table 1. Population and adherence estimates.

Number of individuals per cross-sectional adherence scenario
Scenario	Eligible screeners		Potential screeners		Never-screeners
	Ages 50–75	Ages 45–75	Ages 50–75	Ages 45–75	Ages 50–75	Ages 45–75
Perfect adherence	301,920	368,480	301,920	368,480	N/A	N/A
Imperfect (High and low) adherence	301,920	368,480	229,459	280,045	72,461	88,435
Cross-sectional adherence from real-world estimates
Screening modality	Initial Screening adherence		Subsequent screening tests		Dx colonoscopy adherence for positive stool-based tests
Perfect adherence^a
MT-sDNA, 3-year	100%		100%		100%
FIT, 1-year	100%		100%		100%
Colonoscopy, 10-year	100%		100%		N/A
High adherence
MT-sDNA, 3-year	71.1%^27		86.1%^b		98.6%^b
FIT, 1-year	64.7%^24		86.1%^26,c		98.6%^24
Colonoscopy, 10-year	64%^23		64%^23		N/A
Low adherence
MT-sDNA, 3-year	67.5%^25		54%^b		55.6%^b
FIT, 1-year	48%^26		54%^28		55.6%^29
Colonoscopy, 10-year	38%^16		38%^16		N/A

Abbreviation. Dx: Diagnostic.

^aAssumption. ^bAssumed same as FIT. ^cBest of years 2, 3, and 4 (75.3%, 83.4% and 86.1%).

Figure 1. Screening mix and adherence.

Table 2. Key clinical parameters.

Age Band	Sensitivity (%)
	Mt-sDNA^Citation33			FIT^Citation33			CY^Citation5			Diagnostic CY^Citation5^,^a
	CRC (%)	Adv And (%)	Non adv and (%)	CRC (%)	Adv And (%)	Non adv and (%)	CRC (%)	Adv And (%)	Non adv and (%)	CRC (%)	Adv And (%)	Non-adv and (%)
50–54	92.3	38.0	17.2	73.8	23.8	7.6	95.0	95.0	80.0	95.0	95.0	80.0
55–59		38.0
60–64		42.1
65–69		41.5
70–75		46.8
	Specificity (%)
50–54	92.2		^Citation33^,^b	94.9^Citation33			86.0^Citation5			86.0^a
55–59	92.2
60–64	89.0
65–69	85.7
70–75	81.7
	Distribution of adenomas per age band (%)^Citation5^,^Citation30
	0			1			2			3+
50–54	80.0			10.0			3.8			6.3
55–59	74.7			11.8			5.0			8.5
60–64	69.3			14.0			5.5			11.3
65–69	66.4			14.1			6.3			13.3
70–75	60.9			15.4			7.1			16.6

Abbreviations. Mt-sDNA, Multi-target stool DNA; FIT, Fecal immunochemical test; CY, Colonoscopy; CRC, Colorectal cancer; Adv adn, Advanced adenoma; Non-adv adn, Non-advanced adenoma.

^a Assumed to be the same as a screening colonoscopy⁵.

^b Age-adjusted specificity for mt-sDNA and is related to increased shedding of methylated DNA in stool³⁴.

Figure 2. Incremental number of screening events (increased mt-sDNA-status quo), ages 50–75.

Table 3. Clinical outcomes per adherence scenario, ages 50–75 years.

Clinical outcomes	Increased mt-sDNA			Status quo			Incremental (Increased mt-sDNA- Status quo)
	Adherence scenario			Adherence scenario			Adherence scenario
	Perfect	High	Low	Perfect	High	Low	Perfect	High	Low
Longitudinal adherence	100%	80%	76%	100%	80%	76%	0%	0%	0%
Screening colonoscopies	387,332	314,342	323,839	402,309	328,416	347,303	−14,976	−14,074	−23,464
Diagnostic colonoscopies	8,549	7,582	10,420	6,992	5,374	6,641	1,557	2,208	3,778
Surveillance colonoscopies	18,889	15,034	14,833	19,118	15,278	15,282	−229	−244	−449
Total colonoscopies	414,770	336,958	349,091	428,419	349,068	369,226	−13,649	−12,110	−20,135
Mt-sDNA	51,203	47,466	74,441	33,452	24,615	34,538	17,751	22,850	39,903
FIT	53,118	42,850	47,086	55,157	44,770	50,671	−2,039	−1,920	−3,584
Total stool-based screenings	104,321	90,316	121,528	88,609	69,386	85,209	15,712	20,930	36,318
Total screenings^a	491,653	492,351	748,384	490,917	486,100	744,912	736	6,251	3,472
Advanced adenomas detected	9,095	7,525	8,119	9,204	7,616	8,332	−109	−90	−213
Detected CRC cases	127	1,260	1,564	125	1,255	1,564	2	4	1

^aColonoscopy screenings + stool-based tests.

Figure 3. (a) Cost-savings by adherence scenario, payer perspective. The non-monotonic direction of savings is due to the 100% screening naïve youngest age band of the 45–75-year-old cohort. (b) Cost-savings by adherence scenario, IDN perspective.

Figure 4. Incremental costs (in millions) per category (increased mt-sDNA-status quo), payer perspective.

Table 4. Total costs for the IDN perspective, ages 50–75.

Cost category	Increased mt-sDNA			Status quo
	Adherence scenario			Adherence scenario
	Perfect	High	Low	Perfect	High	Low
CRC screening	$402,810,630	$328,803,894	$341,974,788	$420,318,464	$345,016,750	$368,939,367
Surveillance colonoscopies	$20,915,297	$16,715,941	$16,611,739	$21,193,491	$17,009,235	$17,148,690
Diagnostic colonoscopies	$8,927,068	$8,065,686	$11,364,279	$7,073,205	$5,478,284	$6,965,974
Adverse events	$76,147,561	$62,303,427	$65,272,183	$78,890,845	$64,703,863	$69,281,541
CRC treatment	$15,548,055	$179,343,405	$216,984,916	$15,304,521	$178,844,894	$217,078,287
Direct non-medical	$139,676,155	$114,377,453	$121,127,626	$144,690,912	$118,745,917	$128,452,667
Indirect	$337,542,726	$279,023,667	$307,322,600	$340,818,158	$278,599,563	$306,078,742
Total cost	$1,001,567,494	$988,633,473	$1,080,658,130	$1,028,289,595	$1,008,398,506	$1,113,945,268
Total cost rank per adherence level	2	3	1	2	3	1

Table 5. Total costs for the payer perspective, ages 50–75.

Cost category	Increased mt-sDNA			Status quo
	Adherence scenario			Adherence scenario
	Perfect	High	Low	Perfect	High	Low
CRC screening	$469,410,627	$386,555,463	$416,336,390	$478,519,913	$391,364,498	$423,151,259
Surveillance colonoscopies	$22,944,623	$18,338,665	$18,226,424	$23,249,303	$18,660,099	$18,815,277
Diagnostic colonoscopies	$9,778,752	$8,835,642	$12,453,736	$7,750,464	$6,002,679	$7,634,355
Adverse events	$76,147,561	$62,303,427	$65,272,183	$78,890,845	$64,703,863	$69,281,541
CRC treatment	$15,548,055	$179,343,405	$216,984,916	$15,304,521	$178,844,894	$217,078,287
Direct non-medical	$0	$0	$0	$0	$0	$0
Indirect	$0	$0	$0	$0	$0	$0
Total cost	$593,829,619	$655,376,601	$729,273,649	$603,715,045	$659,576,032	$735,960,718
Total cost rank per adherence level	3	2	1	3	2	1

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