title: Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis.
abstract: BACKGROUND
  The Centers for Medicare & Medicaid Services considered whether to reimburse stool DNA testing for colorectal cancer screening among Medicare enrollees.
  
  
  OBJECTIVE
  To evaluate the conditions under which stool DNA testing could be cost-effective compared with the colorectal cancer screening tests currently reimbursed by the Centers for Medicare & Medicaid Services.
  
  
  METHODS
  Comparative microsimulation modeling study using 2 independently developed models.
  
  
  METHODS
  Derived from literature.
  
  
  METHODS
  A cohort of persons aged 65 years. A sensitivity analysis was also conducted, in which a cohort of persons aged 50 years was studied.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Third-party payer.
  
  
  METHODS
  Stool DNA test every 3 or 5 years in comparison with currently recommended colorectal cancer screening strategies.
  
  
  METHODS
  Life expectancy, lifetime costs, incremental cost-effectiveness ratios, and threshold costs.
  
  
  RESULTS
  Assuming a cost of $350 per test, strategies of stool DNA testing every 3 or 5 years yielded fewer life-years and higher costs than the currently recommended colorectal cancer screening strategies. Screening with the stool DNA test would be cost-effective at a per-test cost of $40 to $60 for stool DNA testing every 3 years, depending on the simulation model used. There were no levels of sensitivity and specificity for which stool DNA testing would be cost-effective at its current cost of $350 per test. Stool DNA testing every 3 years would be cost-effective at a cost of $350 per test if the relative adherence to stool DNA testing were at least 50% better than that with other screening tests.
  
  
  RESULTS
  None of the results changed substantially when a cohort of persons aged 50 years was considered.
  
  
  CONCLUSIONS
  No pathways other than the traditional adenoma-carcinoma sequence were modeled.
  
  
  CONCLUSIONS
  Stool DNA testing could be a cost-effective alternative for colorectal cancer screening if the cost of the test substantially decreased or if its availability would entice a large fraction of otherwise unscreened persons to receive screening.
authors.affiliation: Erasmus Medical Center, Rotterdam, the Netherlands. i.vogelaar@erasmusmc.nl
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
authors.forename: Amy B
authors.initials: AB
authors.lastname: Knudsen
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Wilschut
authors.forename: Ann G
authors.initials: AG
authors.lastname: Zauber
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Ballegooijen
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004273:DNA, Neoplasm / Q000032:analysis*; D005243:Feces / Q000737:chemistry*; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D006278:Medicare; D008875:Middle Aged; D012051:Reimbursement Mechanisms; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D004273:DNA, Neoplasm