Modeling analysis of COVID 19-related delays in colorectal cancer screening on simulated clinical outcomes

ABSTRACT Objective Colorectal cancer (CRC) screening disruptions observed during the COVID-19 pandemic put patients at risk for more advanced-stage disease when diagnosed. This budget impact simulation model assessed increased use of multi-target stool DNA [mt-sDNA] or fecal immunochemical [FIT] tests to offset disruption in colonoscopy screening due to COVID-19 in adults at average-risk for CRC, from a United States payer perspective Main outcomes and measures Compared to the base case (S0; 85% colonoscopy and 15% non-invasive tests), the estimated number of missed CRCs and advanced adenomas (AAs) were determined for four COVID-19-affected screening scenarios: S1, 9 months of CRC screening at 50% capacity, followed by 21 months at 75% capacity; S2, S1 followed by increasing stool-based testing by an average of 10% over 3-years; S3, 18 months of CRC screening at 50% capacity, followed by 12 months of 75% capacity; and S4, S3 followed by increasing stool-based testing by an average of 13% over 3-years. Results Increasing the proportional use of mt-sDNA improved AA detection by 6.0% (Scenario 2 versus 1) to 8.4% (Scenario 4 versus 3) and decreased the number of missed CRCs by 15.1% to 17.3%, respectively. Increasing FIT utilization improved the detection of AAs by 3.3% (Scenario 2 versus 1) to 4.6% (Scenario 4 versus 3) and decreased the number of missed CRCs by 12.9% to 14.9%, respectively. Across all scenarios, the number of AAs detected was higher for mt-sDNA than for FIT, and the number of missed CRCs was lower for mt-sDNA than for FIT. Conclusions and relevance Using home-based stool tests for average-risk CRC screening can mitigate the consequences of reduced colonoscopy screening resulting from the COVID-19 pandemic. Use of mt-sDNA led to fewer missed CRCs and more AAs detected, compared to FIT. Key Points Question What is the impact of increasing the use of stool-based screening tests for colorectal cancer (CRC) during the COVID-19 pandemic in the United States? Findings In this simulation model, increasing the use of stool-based screening tests increased the number of advanced adenomas detected and decreased the number of missed CRC cases. Use of multi-target stool DNA (mt-sDNA) resulted in a higher number of advanced adenomas detected and a lower number of missed CRC cases compared to fecal immunochemical testing (FIT). Meaning Increased use of mt-sDNA led to fewer missed CRC cases and more advanced adenomas detected, compared to FIT, when simulating reduced colonoscopy screening resulting from the COVID-19 pandemic.