Closing the loop in colorectal cancer screening: real-world adherence to follow-up colonoscopy after positive mt-sDNA vs FIT/FOBT, stratified by payer type.

Abstract

Introduction: A positive result from a multi-target stool DNA (mt-sDNA) test, fecal immunochemical test (FIT), or fecal occult blood test (FOBT) requires timely follow-up colonoscopy (FU-CY) to minimize colorectal cancer (CRC) incidence and reduce CRC-related mortality. To examine differences in FU-CY adherence between patients who received a positive mt-sDNA test or FIT/FOBT result by payer type.

Methods: This retrospective analysis utilized a large national claims database linked to the Exact Sciences Laboratories database, which covers over 20 million individuals. Eligible patients were 45-75 years of age and had a positive result between 1/01/2017 and 6/30/2022, with the first test result serving as the index date. Primary outcomes included FU-CY adherence and time to colonoscopy completion.

Results: A total of 362,646 (mt-sDNA n = 292,300; FIT/FOBT n = 70,346) patients with a positive result were identified during the study period. Overall adherence to FU-CY was significantly (p<.001) higher for the mt-sDNA test cohort (77.1%) compared to the FIT/FOBT cohort (45.1%). By payer type, FU-CY adherence for patients in the mt-sDNA test cohort was highest in those covered by commercial insurance (80.7%) and lowest in those with Medicaid (69.8%); for patients in the FIT/FOBT cohort, commercial insurance coverage (42.3%) was lower than for other payer types (47.4-47.9%). In the regression analysis, FU-CY adherence was significantly (p<.001) higher following screening with mt-sDNA than FIT/FOBT across payer types, sex, and race/ethnicity. Within 180 days, FU-CY rates across payer types were high ranging from 62.7%-74.9% following a positive mt-sDNA test, compared to 36.1%-42.5% observed for FIT/FOBT.

Conclusion: In this large, comprehensive study combining two national databases, overall, as well as across each payer type, adherence to FU-CY was substantially higher in patients that initially screened with mt-sDNA compared with FIT/FOBT. In addition, FU-CY rates within 180 days were significantly higher in patients that had a positive mt-sDNA test.