Modeling Study Compares Clinical and Economic Performance of CRC Screening Tests
A 10-year modeling study found that fecal immunochemical testing (FIT) remained the most cost-effective colorectal cancer (CRC) screening strategy for average-risk adults aged 45 years and older, while a multitarget stool RNA (mt-sRNA) test demonstrated the greatest clinical benefit among molecular screening options.
Investigators used a Markov model to simulate CRC progression and compared screening with mt-sRNA (ColoSense), two multitarget stool DNA (mt-sDNA) tests (Cologuard and Cologuard Plus), a blood-based circulating cell-free DNA (cfDNA) test (Shield), and FIT. Outcomes were evaluated against both colonoscopy-based screening and no screening. Model calibration and validation were performed using previously reported Cancer Intervention Surveillance Modeling Network (CISNET) models.
Among the molecular tests evaluated, mt-sRNA detected the greatest number of advanced adenomas, referred the largest number of patients for surveillance, and prevented the most CRC cases and deaths.
At a real-world adherence rate of 60%, mt-sRNA reduced CRC cases and deaths by 1% and 14%, respectively, compared with FIT. Compared with mt-sDNA, mt-sRNA reduced CRC cases by 21% and deaths by 19%. The reductions were 28% and 23% compared with mt-sDNA+, and 80% and 86% compared with cfDNA.
Among triennial molecular screening options, mt-sRNA emerged as the most cost-effective approach. Relative to the mt-sRNA screening program, the cost to prevent one CRC case was 30% higher with mt-sDNA, 45% higher with mt-sDNA+, and 642% higher with cfDNA. Similarly, the cost to prevent one CRC death was 30%, 41%, and 1040% higher, respectively.
The investigators concluded that “FIT was the most cost-effective strategy for preventing CRC cases and deaths.” They also reported that “mt-sRNA demonstrated the greatest clinical benefit and was more cost-effective than other molecular strategies” at real-world adherence rates.
Reference
Shaukat A, Levin TR, Liang PS, et al. Cost-effectiveness of novel noninvasive screening tests for colorectal neoplasia. Clin Gastroenterol Hepatol. 2026;24(7):2007-2018. doi:10.1016/j.cgh.2025.06.006
