Cost-effectiveness of multitarget stool DNA testing for colorectal cancer screening in Chinese primary healthcare settings: a modelling study

AIM: To evaluate the cost-effectiveness of a one-time mt-sDNA-based colorectal cancer screening program compared with no screening, using real-world data from a government-led population-based screening program in Harbin Municipality of China. METHODS: This modelling study was based on a real-world mt-sDNA CRC screening program in Chinese primary healthcare settings. The program targeted residents aged 45-64 years without a prior history of CRC. A decision analytic model was developed from the healthcare system perspective to compare mt-sDNA screening with a hypothetical no-screening scenario. Costs included mt-sDNA testing, diagnostic colonoscopy after positive results, adenoma resection, and colorectal cancer treatment by disease stage. Effectiveness was measured in quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), assessed against a willingness-to-pay threshold of CNY 166,744 per QALY gained. Costs and QALYs were discounted at 5% annually over a lifetime horizon. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis with 10,000 simulations were conducted. RESULTS: ± 50% variation in cost). All ICERs remained below the cost-effectiveness threshold. CONCLUSIONS: The mt-sDNA screening is cost-effective compared to no screening. These findings provide economic evidence to support the large-scale adoption of mt-sDNA-based screening in China.