Shan Jiang and Hector Velasquez-Garcia
Background and objective: Stool DNA (sDNA) test is a brand-new approach for colorectal cancer screening. Compared to previous screening methods (colonoscopy, Flexible sigmoidoscopy, Guaiac fecal occult blood test, and Fecal Immunochemical Test), sDNA performs better in clinical utility, mortality, and adverse events due to the non-invasive property. There is no study before that considers clinical performances and patient’s utilities comprehensively to compare the available screening methods.
Methods: This study built a complete decision tree for colon cancer screening choices, and analyzed the decision question based on parameters of clinical performances, patients’ utilities, and adverse events.
Results: The decision tree shows sDNA has the highest integrated utility, 0.6024. The gFOBT provides second best integrated utility of 0.5509; the utility of FIT is 0.4812, followed by 0.4222 for colonoscopy and 0.1915 for FSIG. If the integrated utilities above be modified by participation rate of each approach, colonoscopy provides integrated utility of 0.3631, higher than 0.292 for gFOBT and 0.255 for FIT. The FSIG still performs worst, with a modified integrated utility at 0.0747. The sDNA will have the highest integrated utility if the hypothetical participation rate is higher than 60.3%.
Conclusion: This study provided clinical evidence that sDNA has highest integrated utility for people in screening program and thus should be recommended to averagerisk population.