Member Adherence to a Health Insurer-Sponsored Gap Closure Program Using Multi-Target Stool DNA Test for Colorectal Cancer Screening
Mallik Greene, Timo Pew, Quang A. Le, Alisdair R. Philp, William K. Johnson, A. Burak Ozbay, John B. Kisiel, Michaël Doré, Derek W. Ebner, A. Mark Fendrick, Paul J. Limburg
Abstract
OBJECTIVES: ) tests. METHODS: Combined patient data from Exact Sciences Laboratories LLC and data from mass-mailed mt-sDNA orders placed by a large Medicare Advantage Insurance Plan were analyzed (03/01/2023-06/30/2023). Adherence and time to test return were the primary and secondary outcomes, respectively. Their association with patient characteristics was evaluated using multivariable regression. RESULTS: Among the 3201 member-patients included (86.6% aged 65-75 years; 58.7% female), adherence rate was 49.4%, and mean time to test return was 25.5 days. After multivariable adjustment, the odds of test return were significantly higher among 65- to 75-year-olds (odds ratio [OR] = 1.59 relative to 45- to 64-year-olds), those living in small towns (OR = 1.43 relative to metropolitan-located individuals), and with digital outreach via both SMS and email (OR = 4.31 relative to no digital outreach). Time to test return was shorter in 65- to 75-year-olds than in 45- to 64-year-olds and was not associated with other patient characteristics. CONCLUSIONS: Mass-mailed mt-sDNA tests for CRC screening were associated with an overall adherence rate of about 50% in this Medicare Advantage population, with higher likelihood of test return among patients receiving digital outreach.