Prioritizing Blood-Based Colorectal Cancer Tests May Lead to Higher Costs, Worse Outcomes

In a federally qualified health care setting, prioritizing noninvasive colorectal cancer (CRC) blood tests over existing stool-based tests may lead to higher costs and worse outcomes, a study finds.¹

Despite the availability of several noninvasive tests for colorectal cancer, prioritizing blood-based tests may result in higher costs and worse population-level outcomes. | Image credit: luchschenF - stock.adobe.com

The findings from this validated microsimulation model, published in JAMA Network Open, warn that novel screening modalities should be carefully evaluated in community settings before being implemented.

“This simulation study examines the benefits, costs, and cost-effectiveness of noninvasive screening tests when adherence to this multistep screening process reflects adherence rates in populations receiving care at FQHCs [Federally Qualified Heath Centers],” wrote the researchers of the study. “Stool-based tests were a cost-effective screening approach, even with low adherence to both noninvasive screening and follow-up colonoscopy.”

Currently, there are 2 FDA-approved blood-based tests for CRC screening in people who are at average risk.² These tests are Shied and Epi proColon. These tests can screen for possible signs of CRC or pre-cancerous polyps in a patient’s blood. Another option are stool-based tests, which are typically done at home. However, these tests need to be done more often, with an abnormal test result requiring a colonoscopy to determine if the individual has cancer.

The study utilized a validated microsimulation model to project CRC screening outcomes for a simulated cohort of 10 million individuals.¹ This cohort represented a predominantly Hispanic or Latino population, characteristic of patients served by a Federally Qualified Health Center (FQHC) in Southern California. The simulated population had low adherence rates to key screening steps, including first-step noninvasive testing (45%), second-step follow-up colonoscopy after abnormal noninvasive results (40%), and ongoing surveillance colonoscopy for patients with high-risk findings (80%).

Screening strategies included no screening, annual or biennial fecal immunochemical test (FIT), triennial multitarget stool DNA test, and triennial blood-based test. The researchers assumed a blood-based test would increase first-step adherence by 17.5%.

The main outcomes were CRC incidence and mortality, life-years gained and quality-adjusted life-years gained relative to no screening, costs, and net monetary benefit assuming a willingness to pay $100,000 per quality-adjusted life-year gained.

Under realistic adherence rates, annual FIT emerged as the most effective and cost-effective colorectal cancer screening strategy, yielding 121 life-years gained per 1000 screened individuals and a net monetary benefit of $5883 per person. In contrast, triennial blood testing was the least effective strategy, producing only 23 life-years gained per 1000 individuals and a negative net monetary benefit, failing to meet cost-effectiveness thresholds.

Even under perfect adherence conditions, triennial blood testing (77 life-years gained per 1000 patients) was outperformed by annual FIT with realistic adherence levels (88 life-years gained per 1000 patients), highlighting FIT’s superior balance of effectiveness and cost efficiency in community health care settings.

However, the researchers acknowledged the study had several limitations. First, adherence rates were based on observed rates in FQHCs, allowing individuals to miss multiple tests while the model assumed a single level of adherence over time and relied on a prespecified screening schedule. Second, while CRC screenings involve short-term costs and long-term benefits, many individuals transition out of the FQHC system upon reaching Medicare eligibility, which may improve adherence with consistent insurance coverage.

Despite these limitations, the researchers find that annual FIT may be the most effective and cost-effective noninvasive screening option for CRC.

“Setting health policy based on increasing adherence to noninvasive screening, without considering effectiveness and adherence to follow-up colonoscopy, could waste health care resources and result in inferior patient outcomes,” wrote the researchers.

References

1. Nascimento de Lima P, Matrajt L, Coronado G, et al. Cost-effectiveness of noninvasive colorectal cancer ccreening in community clinics. JAMA Netw Open. 2025;8(1):e2454938. doi:10.1001/jamanetworkopen.2024.54938

2. Colorectal cancer screening tests. American Cancer Society. Accessed January 16, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html.