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

Ann Intern Med. 2010 Sep 21;153(6):368-77. doi: 10.7326/0003-4819-153-6-201009210-00004.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adenoma / diagnosis
  • Aged
  • Carcinoma / diagnosis
  • Colorectal Neoplasms / diagnosis*
  • Computer Simulation
  • Cost-Benefit Analysis
  • DNA, Neoplasm / analysis*
  • Feces / chemistry*
  • Humans
  • Mass Screening / economics*
  • Medicare
  • Middle Aged
  • Reimbursement Mechanisms
  • Sensitivity and Specificity
  • United States


  • DNA, Neoplasm