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Updated: Jun 20, 2026
Evaluation of Colorectal Cancer Risk and Prevalence by Stool DNA Integrity Detection
Published on: June 8, 2020
Real-World Completion of Multitarget Stool DNA Testing Among Texas Medicare Beneficiaries: Associations With Payer
Timothy Ritter1, Shrey Gohil2, Betthany Thomas2
1GI Alliance Research, Southlake, Texas.
Background:
Colorectal cancer is a leading cause of cancer-related morbidity and mortality in the United States; however, a substantial proportion of eligible adults do not complete screening.
Objectives:
To evaluate real-world completion of multitarget stool DNA (mt-sDNA) testing for colorectal cancer screening among Medicare beneficiaries in Texas and to identify beneficiary-, provider-, and outreach-related factors associated with test completion.
Methods:
This retrospective cohort study included Texas beneficiaries aged 65 to 85 years with traditional Medicare or Medicare Advantage coverage who received an mt-sDNA kit between October 2014 and December 2024. Completion was defined as return of a valid test kit within 1 year of shipment. Multivariable logistic regression was used to identify factors associated with completion. Kaplan-Meier and Cox proportional hazards models were used to evaluate time to kit return.
Results:
Among 710 515 beneficiaries, 538 377 (75.8%) completed mt-sDNA testing within 1 year. Completion was higher among beneficiaries with traditional Medicare vs Medicare Advantage (81.7% vs 71.7%). In adjusted analyses, gastroenterologist ordering (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.53-2.79), full digital outreach (OR, 1.73; 95% CI, 1.69-1.77), and prior mt-sDNA use (OR, 1.61; 95% CI, 1.59-1.64) were associated with higher odds of completion. Higher neighborhood income and lower social vulnerability were also associated with higher completion rates. Time-to-event analyses were consistent, with faster completion observed among patients receiving digital outreach, with prior mt-sDNA use, and those with gastroenterologist-ordered tests.
Discussion:
These findings suggest that both patient context and modifiable care delivery factors influence screening completion and may inform the design of more effective and equitable CRC screening programs.
Conclusions:
In this large real-world Medicare cohort, mt-sDNA completion was high overall but varied by payer type, provider specialty, outreach modality, and socioeconomic vulnerability.
