CT colonography demonstrates ‘superior’ performance and cost savings vs. stool-based testing
Computed tomography colorectal cancer screening is superior in performance and cost savings when compared to the stool-based alternative, according to new research published Tuesday.
The disease is largely preventable but remains the second-leading cancer killer in the U.S., experts write in RSNA’s Radiology. Colonoscopy continues to be the dominant screening method, though radiologists hope Medicare’s recent decision to cover CT-based screening could grant the modality greater mindshare across the country.
Researchers recently investigated the effectiveness of CTC, weighing it against stool-based testing—both ideal options for those seeking a less-invasive alternative to colonoscopy that does not require sedation. They found computed tomography to be the clear winner, while also offering other additional benefits.
“Among the safe, minimally invasive colorectal cancer screening options, CT colonography is more effective at preventing and detecting cancer—and is also more cost-effective—than stool DNA testing,” lead author Perry J. Pickhardt, MD, a professor of radiology and medical physics at the University of Wisconsin, said in a June 10 announcement from the Radiological Society of North America. “Furthermore, CT colonography can provide for extracolonic screening for things like osteoporosis and cardiovascular disease,” he added.
Researchers conducted a modeling study to reach their findings, simulating the progression of colorectal cancer among 10,000 hypothetical 45-year-olds. They found that about 7.5% of the study population developed the disease in the absence of screening, consistent with previous investigations. Both methods were effective when compared to no screening, the authors reported. However, CT demonstrated a higher reduction of cancer incidence at 70% to 75% compared to 59% for the alternative noninvasive option.Meanwhile, stool testing also was found to be economical versus no screening at all, with an estimated cost of almost $9,000 per quality-adjusted life-year gained. That’s compared to conventional CTC, which produced cost savings relative to no screening.
The study investigated two alternative approaches to deploying computed tomography for colorectal cancer screening. They compared the practice of referring patients with detected polyps greater or equal to 6 millimeters in size for a colonoscopy versus a “hybrid strategy.” The latter involved three-year surveillance for small polyps between 6 to 9 millimeters in size. Colonoscopy referral was not cost-effective compared to the hybrid strategy. That’s because of higher costs related to colonoscopy referral for smaller polyps, which was not sufficiently offset by the corresponding small gains in quality-adjusted life years, the authors noted.
“A strategy consisting of three-year surveillance for small colorectal polyps and colonoscopy referral for large polyps [greater than 10 mm] achieved the best overall balance,” RSNA reported in its announcement.
In a corresponding editorial, experts said this study provides “important foundational work” demonstrating CTC’s value, along with its “superior performance and cost savings” versus stool-based testing.
“Given recent Centers for Medicare and Medicaid Services coverage of CTC for [colorectal cancer] screening, this study and its conclusions are more important than ever,” wrote radiologists Samuel Galgano, MD, and Elainea N. Smith, MD, with the University of Alabama at Birmingham. “As the U.S. healthcare landscape continually strives to improve quality and reduce costs, studies such as this are essential in guiding clinical practice guidelines and screening strategies.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.