OBJECTIVES: To assess costs and cost effectiveness of CTC compared with BE in patients with symptomatic colorectal cancers from the UK NHS perspective. METHODS: A Markov model with Monte Carlo simulation was developed to assess the costs, life years and quality adjusted life years associated with CTC vs. BE in patients with symptoms suggestive of bowel cancer.  The initial diagnostic findings, follow up investigations for suspected colonic lesions, confirmed diagnoses, and resources used were estimated from individual patient data from the SIGGAR trial. We extrapolated the trial results over a patient’s life time. Transition probabilities among small polyps, large polyps and different stages of cancer, and the costs and utilities associated with each state, were derived from the literature. Outcomes were measured as incremental cost per life year saved and incremental cost per quality adjusted life year (QLAY) gained. Probabilistic sensitivity analysis was conducted across key input values. RESULTS: The Mean life time costs required to reach a diagnosis were £658 and £718 for BE and CTC trial arms respectively leading to a mean difference of £61 for each patient having a diagnostic test. The (discounted) life years obtained were 9.943 and 9.975, and (discounted) QALYs were 8.900 and 8.938 for BE and CTC respectively leading to 0.032 life years, 0.038 QALYs advantaged for CTC. The incremental costs per life year gained was £1,856 (£1,133 without discounting), and per QALYs gained at £1,598 (£969 without discounting) for CTC compared with BE. The probabilistic sensitivity analysis produced that the probability of CTC being cost effective was 75% at a willingness-to pay value of £20,000 for a QALY gained. CONCLUSIONS: This analysis showed that CTC was clearly cost effective over BE.  Therefore CTC should be recommended in place of BE as one of the primary diagnostic methods for patients referred with symptoms suggestive of colorectal cancer.