OBJECTIVES: New cancer screening technology using blood, stool or urine samples are currently in various stages of development and could revolutionize early detection of cancer. The objective of this modeling study was to assess the effectiveness and cost of a hypothetical future colorectal cancer screening test to identify the cost threshold under which the test would be considered cost-effective. These tests will not only differ in cost, but also in sensitivity and specificity for polyps and cancer, and in screening intervals. All these differences in test characteristics can impact their cost-effectiveness.

METHODS: We used a validated microsimulation model which consists of three interlinked components, risk assessment, natural history, and screening/treatment modules, to conduct the analysis. We created a synthetic population that mimics the profile of the US population using data drawn from the National Health Interview Survey and peer-reviewed literature. We used a range of sensitivity and specificity measures based on published studies and varied the cost of the screening test from $100 to $1000.

RESULTS: Preliminary results indicate that tests which cost less than $400 remained cost-effective. A cost of $600 or more resulted in incremental cost per life year gained of more than $100,000. Adherence with follow-on diagnostic testing and repeat testing within specified intervals had the largest impact on the cost-effectiveness of the test. Additionally, the type and number of follow-up tests required to make a conclusive diagnosis had a substantial impact on cost-effectiveness.

CONCLUSIONS: This study provides guidance on the potential effectiveness and cost of future colorectal cancer screening tests. Understanding the cost drivers and the robustness of the cost-effectiveness estimates can help inform policy decisions related to payment and coverage. Colorectal cancer remains a leading cause of mortality and therefore identifying optimal screening tests is a priority.