In general fecal DNA testing was found to be cost-effective compared to no screening, but was less cost-effective than other currently available screening options, mainly gFOBT and FIT. Carcino-embryonic antigen (CEA), a conventional cancer marker that has been considered as a blood-based screening option, exhibited limited sensitivity and specificity [131]. Ladabaum et al [130] compared screening with a methylated Septin 9 DNA plasma assay (SEPT9) to screening with gFOBT, FIT, sigmoidoscopy and colonoscopy. Like the overall stool-based DNA testing, SEPT9 was cost-effective compared to no screening, but its cost-effectiveness is less than gFOBT and FIT. The high unit costs of fecal DNA tests, compared to FOBT are a major driver for this observation.
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Technological advances might allow reductions in unit costs, which would improve the cost-effectiveness of fecal DNA testing. It is estimated that fecal DNA testing at a screening interval of two years would have a similar amount of life years gained compared to colonoscopy every ten years [125]. In this scenario the fecal DNA test would need to cost 195 dollars or less in order to be cost-effective. When compared to FIT screening, however, the unit cost of current fecal DNA tests would need to decrease to about 40 to 60 US dollars in order to provide a cost-effective alternative [127,
Technological advances might allow reductions in unit costs, which would improve the cost-effectiveness of fecal DNA testing. It is estimated that fecal DNA testing at a screening interval of two years would have a similar amount of life years gained compared to colonoscopy every ten years [125]. In this scenario the fecal DNA test would need to cost 195 dollars or less in order to be cost-effective. When compared to FIT screening, however, the unit cost of current fecal DNA tests would need to decrease to about 40 to 60 US dollars in order to provide a cost-effective alternative [127,