November 13, 2025
CT Colonography Most Cost-Effective Colorectal Cancer Screening Strategy for Black Adults
New study finds CT colonography delivers greater value than colonoscopy and FIT for Black adults under real-world screening adherence, supporting expanded use
Reston, VA — A new study published in Cancer Medicine by the Harvey L. Neiman Health Policy Institute and Northwell Health demonstrates that CT colonography (CTC) is the most cost-effective colorectal cancer screening strategy for Black adults when real-world adherence patterns are taken into account. The findings underscore the importance of Centers for Medicare & Medicaid Services (CMS) expanded coverage for CTC that began in January 2025 and are a call to action to increase the use of CTC to reduce colorectal cancer disparities.
Colorectal cancer remains one of the most common cancers in the United States, with medical costs expected reach $26 billion in 2025. Despite overall declines in colorectal cancer incidence due to increased screening rates, non-Hispanic Black adults continue to experience disproportionately higher rates of the disease. Colorectal cancer screening by colonoscopy and stool-based tests have not fully addressed these disparities—particularly given race-based differences in patient adherence.
“We found that CTC was the most cost-effective screening strategy for Black adults, both men and women. As such, CTC delivers strong value for Black adults, who face unique barriers to traditional screening,” said senior author Pina C. Sanelli, MD, MPH, Vice Chair of Research at Northwell Health. “CTC was found to be cost-saving compared to no screening for white adults, but current real-world screening practices (the mix of available screening methods as observed among White adults) were most cost-effective for this group.”
“Demonstrating the superiority of CTC for colorectal cancer screening among Black Americans is critical information for increasing screening in this group that is losing ground with respect to colon cancer outcomes,” said co-author Judy Yee, MD, Professor and Chair of Radiology at Montefiore Health System of the Albert Einstein College of Medicine “Our research team hopes that this evidence is translated into action to increase screening rates and close the gap on disparities.”
CTC is a non-invasive imaging test that offers adenoma detection superior to stool-based tests and cancer detection equivalent to colonoscopy, but with reduced patient burden in terms of time, need for sedation, and recovery. Previous research has shown that Black adults are more willing to undergo CTC, highlighting its potential to reduce disparities in CRC outcomes.
The new study used an advanced microsimulation model to compare five colorectal cancer screening strategies across race and gender, incorporating U.S. data from 2010–2019 on disease progression and real-world adherence. “Cost-effectiveness studies are a cornerstone of health economics because they help us understand not just whether a medical intervention works, but whether it provides sufficient value for the resources invested,” explained Dr. Sanelli.
“Unlike prior studies that assumed perfect adherence, this analysis revealed that accounting for real-world adherence by screening type and separately by demographic group is critical to accurately estimating cost-effectiveness,” said primary author Zoe Kao, PhD, senior health economist, Siemens Healthineers. “By accounting for differences in adherence by race and sex, we found that CTC is not only clinically effective but also cost-effective for Black adults.”
“Despite its promise, CTC has been underutilized, in part due to the lack of CMS coverage prior to 2025. A prior Neiman Institute study found that Medicare patients in higher-income areas were often paying out of pocket for CTC rather than undergoing colonoscopy, resulting in nearly a 6 times higher rate of CTC use for screening.”[1] said coauthor Elizabeth Rula, PhD, executive director at the Neiman Institute.
“CMS should be applauded for expanding Medicare coverage to include CT colonography, which we show is superior to colonoscopy and stool-based tests for reducing disparities in Black Americans,” added Dr. Rula. “Physicians and insurance providers should channel these promising results into efforts to increase colorectal cancer screening rates by expanding the use of CTC.”
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, LinkedIn and Facebook.