CTC: A Cost-Effective and Accessible CRC Screening Tool for Black Adults
CT colonography (CTC) is a promising screening method for colorectal cancer (CRC) among Black adults, according to recent research. The study, published in Cancer Medicine, highlights the potential of CTC to address racial disparities in CRC screening and improve health outcomes.
The research team, led by Szu-Yu Zoe Kao, PhD, from Siemens Medical Solutions USA, found that CTC is not only cost-effective but also accessible to Black adults. This is particularly significant given the higher incidence of CRC among Black individuals compared to their white counterparts. The study's findings suggest that CTC could be a valuable tool to support Medicare coverage for CRC screening and address specific population needs.
Colorectal cancer (CRC) is a prevalent disease in the U.S., with estimated medical costs reaching $26 billion in 2025. Screening is crucial in detecting precursor polyps and reducing the disease's impact. The most common screening strategies include colonoscopy, CTC, and stool-based tests. However, disparities in screening access and preferences exist between Black and white adults.
Black individuals often opt for stool-based tests, while white adults prefer colonoscopy. These choices may be influenced by structural barriers, such as insurance coverage, physician recommendations, and primary care provider availability. The study emphasizes the need to overcome these barriers to ensure equal access to effective screening methods.
One of the key advantages of CTC is its ability to detect more colorectal adenomas compared to stool-based tests. This translates to 'colonoscopy equivalent cancer detection,' making CTC a valuable tool for addressing racial disparities in CRC screening. Interestingly, Black individuals show a greater willingness to undergo CTC, which further supports its potential to bridge the gap in screening rates between races.
To evaluate the cost-effectiveness of CTC, the research team developed a microsimulation model. This model compared various CRC screening strategies for average-risk adults, considering race and gender. The strategies included the status quo (colonoscopy or fecal immunochemical testing), CTC every five years, colonoscopy every 10 years, annual fecal immunochemical testing, and a multitarget stool DNA test every three years. The model analyzed lifetime costs, quality-adjusted life years gained (QALY), and incremental cost-effectiveness ratios, setting a willingness-to-pay threshold of $100,000/QALY.
The study's main finding was that the CTC strategy outperformed the status quo in terms of QALY and CRC case reduction among Black adults. However, for white adults, the status quo strategy was more effective. The research also revealed that Black adults had higher CRC cases and utilized fecal immunochemical testing more frequently under the status quo strategy compared to white adults. Interestingly, the CTC-only strategy emerged as the dominant choice for Black adults, while the status quo and CTC strategies were optimal for white adults, depending on resource availability.
In conclusion, CTC is a cost-effective and accessible screening tool for Black adults, offering high-quality detection and addressing racial disparities in CRC screening. The study's findings emphasize the importance of considering racial differences in screening strategies to improve health outcomes and reduce the burden of CRC.
