Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis

Iris Lansdorp-Vogelaar, Karen M Kuntz, Amy B Knudsen, Janneke A Wilschut, Ann G Zauber, Marjolein van Ballegooijen

Research output: Contribution to journalArticleAcademicpeer-review

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.

DESIGN: Comparative microsimulation modeling study using 2 independently developed models.

DATA SOURCES: Derived from literature.

TARGET POPULATION: A cohort of persons aged 65 years. A sensitivity analysis was also conducted, in which a cohort of persons aged 50 years was studied.

TIME HORIZON: Lifetime.

PERSPECTIVE: Third-party payer.

INTERVENTION: Stool DNA test every 3 or 5 years in comparison with currently recommended colorectal cancer screening strategies.

OUTCOME MEASURES: Life expectancy, lifetime costs, incremental cost-effectiveness ratios, and threshold costs.

RESULTS OF BASE-CASE ANALYSIS: 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 OF SENSITIVITY ANALYSIS: None of the results changed substantially when a cohort of persons aged 50 years was considered.

LIMITATION: No pathways other than the traditional adenoma-carcinoma sequence were modeled.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)368-77
Number of pages10
JournalAnnals of Internal Medicine
Volume153
Issue number6
DOIs
Publication statusPublished - 21 Sep 2010

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