Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People

ObjectiveTo estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical (FIT) for Alaska Native adults.Patients MethodsA Markov model was used to evaluate 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence mortality, costs, quality-adjusted life-years (QALYs), incremental ratios (ICERs). The study incorporated updated evidence on performance adherence conducted from December 15, 2016, through November 6, 2019.ResultsWith perfect adherence, CRC reduced by 52% (95% CI, 46% 56%) using colonoscopy, 61% 57% 64%) annual FIT, 66% 63% 68%) MT-sDNA. Compared no screening, extends life 0.15, 0.17, 0.19 QALYs per person MT-sDNA, respectively. Colonoscopy is most expensive strategy: approximately $110 million more than MT-sDNA $127 FIT. With imperfect (best case), resulted in 0.12 vs 0.05 0.06 FIT Probabilistic sensitivity analyses supported base-case analysis. Under varied scenarios, either dominates or cost-effective (ICERs, $1740-$75,868 QALY saved) colonoscopy.ConclusionEach strategy costs increased screening. Screening results largest savings. In analysis, population a wide range scenarios.