Iris Lansdorp-Vogelaar, PhD; Karen M. Kuntz, ScD; Amy B. Knudsen, PhD; Janneke A. Wilschut, MS; Ann G. Zauber, PhD; Marjolein van Ballegooijen, MD, PhD
Lansdorp-Vogelaar I, Kuntz KM, Knudsen AB, Wilschut JA, Zauber AG, van Ballegooijen M. Stool DNA Testing to Screen for Colorectal Cancer in the Medicare Population: A Cost-Effectiveness Analysis. Ann Intern Med. 2010;153:368-377. doi: 10.7326/0003-4819-153-6-201009210-00004
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Published: Ann Intern Med. 2010;153(6):368-377.
The Centers for Medicare & Medicaid Services considered whether to reimburse stool DNA testing for colorectal cancer screening among Medicare enrollees.
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.
Comparative microsimulation modeling study using 2 independently developed models.
Derived from literature.
A cohort of persons aged 65 years. A sensitivity analysis was also conducted, in which a cohort of persons aged 50 years was studied.
Stool DNA test every 3 or 5 years in comparison with currently recommended colorectal cancer screening strategies.
Life expectancy, lifetime costs, incremental cost-effectiveness ratios, and threshold costs.
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.
None of the results changed substantially when a cohort of persons aged 50 years was considered.
No pathways other than the traditional adenomaâ€“carcinoma sequence were modeled.
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.
Agency for Healthcare Research and Quality.
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Gastroenterology/Hepatology, Hematology/Oncology, Healthcare Delivery and Policy, High Value Care, Cancer Screening/Prevention.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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