A cost-effectiveness of Fecal DNA methylation test for colorectal cancer screening in Saudi Arabia

Background In the Saudi Arabia, we estimated the cost-effectiveness between fecal DNA methylation test (FDMT) and fecal immunochemical testing (FIT) to detect colorectal cancer (CRC) and precancerous lesions in the national screening program. Participants and methods A Markov model was used from 45 to 74 years old CRC screening to compare the cost-effectiveness with the FDMT vs FIT. We predicated the longitudinal participation patterns in the perfect adherence vs organized programs screening covered by national budgets. Outcomes incorporated the incidence rates and mortality rates, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs) under the perfect adherence as well as incidence and mortality forecast within 3, 6 and 9 years. Results Under the perfect adherence, the total cost of FDMT was cheaper 38.16% than FIT and extends 0.22 QALYs per person. Furthermore, FDMT was more cost-effective as ICERs ($1487.30 vs $1982.42 per QALY saved) compared with FIT test. Therefore, FDMT test dominated than FIT every year (more costly and less effective). Compared with the organized FDMT programs (6.6% initial positive rate and 54% coloscopy compliance rate), the FIT program (5.8% initial positive rate and 48% coloscopy compliance rate) had 6.25 times to 7.76 times on the incidence rates; 5.12 times to 12.19 times on the mortality rates among 3, 6 and 9 years prediction. Conclusions Through the Markov model, we compared FDMT was less costly and more effective than the FIT test under the perfect and organized adherence within nine years prediction. It implied that FDMT might the novel cost-effective tool for Saudi Arabia national screening program. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors