title: Cost-effectiveness analysis of colorectal cancer screening with stool DNA testing in intermediate-incidence countries.
abstract: BACKGROUND
  The aim of this study is to compare the cost-effectiveness of screening with stool DNA testing with that of screening with other tools (annual fecal occult blood testing, flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years) or not screening at all.
  
  
  METHODS
  We developed a Markov model to evaluate the above screening strategies in the general population 50 to 75 years of age in Taiwan. Sensitivity analyses were performed to assess the influence of various parameters on the cost-effectiveness of screening. A third-party payer perspective was adopted and the cost of dollar 13,000 per life-year saved (which is roughly the per capita GNP of Taiwan in 2003) was chosen as the ceiling ratio for assessing whether the program is cost-effective.
  
  
  RESULTS
  Stool DNA testing every three, five, and ten years can reduce colorectal cancer mortality by 22%, 15%, and 9%, respectively. The associated incremental costs were dollar 9,794, dollar 9,335, and dollar 7,717, per life-year saved when compared with no screening. Stool DNA testing strategies were the least cost-effective with the cost per stool DNA test, referral rate with diagnostic colonoscopy, prevalence of large adenoma, and discount rate being the most influential parameters.
  
  
  CONCLUSIONS
  In countries with a low or intermediate incidence of colorectal cancer, stool DNA testing is less cost-effective than the other currently recommended strategies for population-based screening, particularly targeting at asymptomatic subjects.
authors.affiliation: Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan. gracewu@ntu.edu.tw
authors.forename: Grace Hui-Min
authors.initials: GH
authors.lastname: Wu
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Wang
authors.forename: Amy Ming-Fang
authors.initials: AM
authors.lastname: Yen
authors.forename: Jau-Min
authors.initials: JM
authors.lastname: Wong
authors.forename: Hsin-Chih
authors.initials: HC
authors.lastname: Lai
authors.forename: Jane
authors.initials: J
authors.lastname: Warwick
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
mesh_terms: D003113:Colonoscopy / Q000191:economics; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000235:genetics; D003362:Cost-Benefit Analysis; D004273:DNA, Neoplasm / Q000032:analysis; D005243:Feces / Q000737:chemistry; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D009780:Occult Blood; D019057:Quality-Adjusted Life Years; D012812:Sigmoidoscopy / Q000191:economics
chemical_list: D004273:DNA, Neoplasm