Comparison of Benefit-to-Burden Ratios for Stool-Based Colorectal Cancer Screening Tests in the U.S.: A Decision...

Area of Science:

• Preventive medicine
• Gastroenterology
• Health economics

Background:

• The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer (CRC) screening for average-risk individuals starting at age 45.
• Current recommendations include multitarget stool DNA tests every 1-3 years or annual fecal immunochemical tests (FIT).
• Evaluating the benefit-to-burden ratio of different stool-based screening strategies is crucial for optimizing CRC prevention.

Purpose of the Study:

• To estimate the benefit-to-burden ratio of various stool-based CRC screening strategies.
• To identify efficient screening strategies using updated performance data for multitarget stool DNA and FIT.
• To compare these strategies across recommended intervals and age ranges for average-risk individuals.

Main Methods:

• A decision-analytical model (Colorectal Cancer Adenoma Incidence and Mortality model) was utilized.
• Updated aggregate test performance data from a meta-analysis for next-generation multitarget stool DNA and FIT were incorporated.
• The primary analysis generated an efficient frontier comparing life-years gained (benefit) against lifetime colonoscopies (burden).

Main Results:

• All evaluated stool-based screening strategies demonstrated positive life-years gained compared to no screening (178-352 life-years gained/1,000 individuals).
• Triennial next-generation multitarget stool DNA screening between ages 45 and 75 years emerged as the sole efficient stool-screening strategy within USPSTF-recommended parameters.
• Annual FIT and annual next-generation multitarget stool DNA screening (ages 45-75) were identified as near-efficient strategies.

Conclusions:

• Triennial next-generation multitarget stool DNA screening from ages 45 to 75 years offers the optimal balance of benefits and burdens among recommended stool-based CRC screening strategies.
• This strategy provides superior performance advantages, maximizing life-years gained while minimizing the burden of colonoscopies.
• The findings support the efficiency of this specific stool-based screening approach for average-risk individuals.