OBJECTIVES: Estimate changes in annual utilization and payments for non-invasive colorectal cancer (CRC) screening tests among individuals aged 45-64 years following the 2014 launch of a multitarget stool DNA (mt-sDNA) test.

METHODS: Using 2015-2021 Merative™ MarketScan® Commercial Database, we assessed claims for non-invasive CRC screening tests--fecal immunochemical tests (FIT), fecal occult blood tests (FOBT), and mt-sDNA tests--per enrollee aged 45-64 years in a calendar year. We calculated annual utilization rates, mean total payments per individual, and the percentage of zero out-of-pocket (OOP) payments for each test type.

RESULTS: Annual utilization of non-invasive CRC screening tests decreased, with 12% lower use in 2021 than in 2015. The utilization of FIT and FOBT tests decreased by 22% and 61%, respectively, while the utilization of mt-sDNA test increased from 11 to 1601 per 100,000 enrollees. Mean total payments for mt-sDNA, FIT, and FOBT were $522, $32, and $17 per individual in 2021, respectively. Mean total payment for any non-invasive CRC screening test increased 7.8-fold from $19 to $168. Percentage of paid claims for mt-sDNA tests with zero OOP payment increased from 36% in 2015 to 83% in 2017, reaching 97% in 2021.

CONCLUSIONS: The rapid increase in use of mt-sDNA did not fully offset the decrease in use of FIT and FOBT. However, effective non-invasive screening may have increased overall since mt-sDNA screening may be less frequent than annual FIT or FOBT. The mean cost of testing per individual increased substantially with the substitution of mt-sDNA for FOBT and FIT. The percentage of zero OOP payments for mt-sDNA more than doubled in the years following an updated US Preventive Services Task Force recommendation statement that listed mt-sDNA among CRC screening options.