\n<\/figcaption><\/figure>\nColonoscopies are also still the most cost-effective screening method for colorectal cancer, results of a cohort study conducted by Hernandez and colleagues showed.<\/p>\n
However, when compared with colonoscopy, stool tests are nearly twice as cost-effective as the newer blood tests, according to the study.<\/p>\n
\u201cThe recent approval of blood tests really made a lot of gastroenterologists concerned because it\u2019s such an easy test to do,\u201d Hernandez said.<\/p>\n
\u201cWe really expect that to change the landscape of cancer screening. Fortunately, in our model, we saw a drop but not a significant drop [in total colonoscopies performed], because when a lot of these tests turn positive, it will lead to more procedures and colonoscopies.\u201d<\/p>\n
Hernandez and colleagues used a cohort Markov model to follow 1 million adults aged 45 to 75 years in yearly cycles to project U.S. annual test volumes for CRC screening strategies while comparing cost-effectiveness.<\/p>\n
The study used registry and epidemiologic data to evaluate test performance, compliance with colonoscopy after positive tests with noninvasive strategies and costs of each testing method.<\/p>\n
From 2026 to 2035, total annual colonoscopy volume is projected to decline from 27 million to 22.3 million, while screening colonoscopy volume is expected to drop from 13 million to 8.3 million. Both diagnostic colonoscopies (8 million per year) and surveillance colonoscopies (6 million per year) are projected to hold steady.<\/p>\n
Meanwhile, time-series trends project stool test volume to increase from 4.7 million to 7.8 million per year and blood test volume to increase from 2.9 million to 6.1 million during that time.<\/p>\n
Using colonoscopy \u2014 which demonstrated the lowest cost per quality-adjusted life year (QALY) \u2014 as the cost-effectiveness reference, researchers found that stool test strategies yielded an incremental cost-effectiveness ratio (ICER) of $11,500 per QALY, while blood test strategies had an ICER of $21,400 per QALY.<\/p>\n
Researchers noted that the model used in the study did not fully capture the totality of a variety of factors impacting CRC screening, including uptake, payer-level incentives, policy changes and patterns of referring.<\/p>\n
Although these projections show a probable decline in total colonoscopy volume, follow-up on positive results from blood or stool tests should sustain procedural volume and will be crucial in improving outcomes over the next decade.<\/p>\n
\u201cThere\u2019s still a subset of patients who refuse to get a colonoscopy despite being positive,\u201d Hernandez said. \u201cWe\u2019re missing that subset of patients. If we improve the compliance rate of these patients, that would make a huge difference.<\/p>\n
\u201cWe need to collaborate with hospital systems and primary care doctors to improve that compliance rate,\u201d he added. \u201cUsing large language models to alert primary care doctors about who has not done their colonoscopy after a positive blood or stool test would be good. There\u2019s a lot of room for improvement.\u201d<\/p>\n
For more information:<\/h2>\n Lyndon V. Hernandez, MD<\/b>,<\/b> <\/b>can be reached at <\/b> lhernan@mcw.edu .<\/b><\/p>\n\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Hernandez LV, et al. Colorectal cancer screening with colonoscopy, stool, and blood testing: Long-term cost-effectiveness and projected procedure volumes. Presented at: Digestive Disease Week; May 2-5, 2026; Chicago.<\/p>\n
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