Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis.
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.
Lansdorp-Vogelaar
Iris
I
Erasmus Medical Center, Rotterdam, the Netherlands. i.vogelaar@erasmusmc.nl
Kuntz
Karen M
KM
Knudsen
Amy B
AB
Wilschut
Janneke A
JA
Zauber
Ann G
AG
van Ballegooijen
Marjolein
M
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
D004273:DNA, Neoplasm