Cost Comparison: Multitarget Stool DNA Tests vs. FIT for Early Detection of Colorectal Cancer

A recent study published in the Annals of Internal Medicine highlights significant differences in costs between multitarget stool DNA tests (MSDT) and fecal immunochemical tests (FIT) used for screening and early detection of colorectal cancer (CRC). The research was conducted by scientists from the German Cancer Research Center in Heidelberg, who analyzed data from two comparative studies evaluating the diagnostic performance, associated costs, and follow-up procedures for these screening tools.

The findings reveal that both MSDT-based tests, such as Exact Sciences' Cologuard, and next-generation MSDTs like Cologuard Plus, incur higher screening costs per case of early-detected advanced neoplasia and CRC compared to FIT. Specifically, when considering follow-up colonoscopy rates at 60%, the costs per detected advanced neoplasia or early CRC were found to be seven to nine times higher for MSDTs than for FIT. For each additional early-detected CRC case, costs were approximately 30 to 40 times higher with MSDT methods.

Researchers also examined various scenarios, including different follow-up colonoscopy uptake rates (30% to 90%) and hypothetical reductions in test costs. Even with lowered costs for MSDTs, the incremental expenses to detect an additional CRC case remained substantially higher than with FIT, often exceeding half a million dollars per case. Notably, increasing colonoscopy follow-up rates further amplified these costs, reaching over $1.4 million for each additional case.

While MSDT and N-G MSDT tests offer higher sensitivity in detecting early-stage colorectal cancer, the study emphasizes that similar diagnostic accuracy can be achieved with FIT by adjusting the positivity threshold, without incurring higher costs. Therefore, the decision between testing modalities should consider both economic and clinical factors.

This research underscores the importance of evaluating cost-effectiveness in colorectal cancer screening strategies, especially given the varying resources and healthcare policies across regions. The findings suggest that, despite their superior sensitivity, advanced stool DNA tests may not be cost-efficient for widespread screening programs compared to FIT, especially at current price points.

Source: https://medicalxpress.com/news/2025-05-multitarget-stool-dna-early-colorectal.html