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
Disclaimer: The authors of this report are responsible for its contents. The findings and conclusions do not necessarily represent the views of the Agency for Healthcare Research and Quality. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Martin Brown, PhD, and Robin Yabroff, PhD, of the National Cancer Institute for their assistance with obtaining cancer treatment costs using SEER-Medicare data; Joan Warren, PhD, and Carrie Klabunde, PhD, of the National Cancer Institute for sharing their preliminary analysis of SEER-Medicare data on colonoscopy-related complications; John Allen, MD, of Minnesota Gastroenterology and Joel Brill, MD, of Predictive Health for their assistance in deriving coding for screening and complications; William Larson, Marjorie Baldo, and Marilu Hu of the CMS for providing CMS cost data; Chuck Shih of the Agency of Healthcare Research and Quality for interpreting the CMS cost data; William Lawrence, MD, and Kim Wittenberg, MA, of the Agency for Healthcare Research and Quality for contextual and administrative assistance, respectively; and Eric (Rocky) Feuer, PhD, of the National Cancer Institute for continued support of the work and infrastructure of the Cancer Intervention and Surveillance Modeling Network consortium.
Grant Support: By the Agency for Healthcare Research and Quality (HHSP233200700123P, HHSP233200700196P, HHSP233200700350P) and the National Cancer Institute (U01-CA-088204, U01-CA-097426, and U01-CA-115953).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0564.
Reproducible Research Statement:Study protocol: Available to approved individuals with written agreement from Dr. Lansdorp-Vogelaar (e-mail, firstname.lastname@example.org). Statistical code and data set: Not available.
Requests for Single Reprints: Iris Lansdorp-Vogelaar, PhD, Department of Public Health, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands; e-mail, email@example.com.
Current Author Addresses: Dr. Lansdorp-Vogelaar, Ms. Wilschut, and Dr. van Ballegooijen: Department of Public Health, Erasmus Medical Center, Dr. Molewaterplein 50, Rotterdam 3000 CA, the Netherlands.
Dr. Kuntz: Division of Health Policy and Management, University of Minnesota, MMC 729 Mayo, 15-232 PWB, 516 Delaware Street Southeast, Minneapolis, MN 55455.
Dr. Knudsen: Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA 02114.
Dr. Zauber: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065.
Author Contributions: Conception and design: I. Lansdorp-Vogelaar, K.M. Kuntz, A.G. Zauber, M. van Ballegooijen.
Analysis and interpretation of the data: I. Lansdorp-Vogelaar, K.M. Kuntz, A.B. Knudsen, J.A. Wilschut, A.G. Zauber, M. van Ballegooijen.
Drafting of the article: I. Lansdorp-Vogelaar, K.M. Kuntz, A.B. Knudsen, A.G. Zauber, M. van Ballegooijen.
Critical revision of the article for important intellectual content: I. Lansdorp-Vogelaar, K.M. Kuntz, A.B. Knudsen, A.G. Zauber, M. van Ballegooijen.
Final approval of the article: I. Lansdorp-Vogelaar, K.M. Kuntz, A.B. Knudsen, J.A. Wilschut, M. van Ballegooijen.
Provision of study materials or patients: A.G. Zauber.
Statistical expertise: K.M. Kuntz, A.G. Zauber.
Obtaining of funding: I. Lansdorp-Vogelaar, K.M. Kuntz, A.G. Zauber, M. van Ballegooijen.
Administrative, technical, or logistic support: A.G. Zauber.
Collection and assembly of data: I. Lansdorp-Vogelaar, A.G. Zauber.
Lansdorp-Vogelaar I., Kuntz K., Knudsen A., Wilschut J., Zauber A., 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.
Rajasree Pai Ramachandra Pai
University of Connecticut Health Center, Farmington
September 22, 2010
The idea of using stool DNA for screening is a good one as it is non invasive and increases the likelihood of patients getting screened. The expenses of patients getting treated surgically and with chemotherapeutic agents over a certain period of time versus costs of using stool DNA for screening needs to be taken into account while discussing cost effectiveness.
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Gastroenterology/Hepatology, Hematology/Oncology, Healthcare Delivery and Policy, High Value Care, Cancer Screening/Prevention.
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