| Summary: | Despite recent declines in both incidence and mortality, colorectal cancer (CRC) is the second most common cause of cancer death in the United States. CRC screening has been shown to reduce CRC mortality by 15-33% in randomized controlled trials with Hemoccult II fecal occult blood testing (FOBT). Novel CRC screening technologies, such as computed tomography (CT) colonography have been developed but need to be evaluated in terms of their comparability of performance (sensitivity and specificity) in detecting adenomatous polyps and CRC, acceptability to patients, and test-related complications and costs. Accordingly, we conducted a cost-effectiveness analysis of CT colonography and other currently recommended CRC screening strategies. We used three microsimulation models from the National Cancer Institute-funded Cancer Intervention and Surveillance Modeling Network (CISNET) consortium to assess the cost-effectiveness of screening for CRC with CT colonography in comparison to the currently-recommended CRC screening strategies. We conducted incremental cost-effectiveness analyses by comparing the incremental costs and benefits with the next best strategy after eliminating dominated strategies (i.e., strategies that are more costly and less effective than another strategy or a combination of other strategies). The analysis was from the payer's (CMS) perspective with costs stated as those which Medicare pays. These payments reflect approximately 80% of the allowable charges, including the facility charges (as applicable) and physician services charges. The patient's co-payment is not reflected in the analysis. We conducted a literature review of the evidence for CT colonography to obtain estimates of its sensitivity and specificity for adenomas by size and for cancer
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