Fecal DNA testing compared with conventional colorectal cancer screening methods: a decision analysis

Area of Science:

• Oncology
• Gastroenterology
• Health Economics

Background:

• Colorectal cancer (CRC) screening is crucial for early detection and prevention.
• Fecal DNA testing (F-DNA) is an emerging tool for CRC detection.
• Conventional screening methods include fecal occult blood testing (FOBT), sigmoidoscopy, and colonoscopy (COLO).

Purpose of the Study:

• To estimate the clinical and economic consequences of F-DNA screening compared to conventional CRC screening methods.
• To evaluate the cost-effectiveness of F-DNA testing for colorectal cancer.

Main Methods:

• A Markov model was utilized to estimate CRC incidence, mortality, and cost per life-year gained.
• The model compared screening strategies including F-DNA, FOBT, sigmoidoscopy, and COLO.
• Analyses were conducted for individuals at average CRC risk aged 50 to 80 years.

Main Results:

• F-DNA screening every 5 years reduced CRC incidence by 35% and mortality by 54%, gaining 4560 life-years per 100,000 persons at $47,700/life-year gained.
• F-DNA resulted in fewer life-years gained and higher costs compared to conventional screening.
• Colonoscopy (COLO) required an average of 3.8 colonoscopies per person, while F-DNA required 0.8, but COLO and FOBT dominated F-DNA in cost-effectiveness.

Conclusions:

• Fecal DNA testing every 5 years is effective and cost-effective compared to no screening for colorectal cancer.
• However, F-DNA is inferior to FOBT and COLO in terms of cost-effectiveness.
• F-DNA could reduce the national CRC burden by improving screening adherence, especially where colonoscopy capacity is limited.