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To estimate the direct medical cost of colorectal neoplasia (CRN) from newly diagnosed to the completion of the tumour-specific treatment in the initial year of disease across stages and tumour primary sites.Only direct medical costs from the perspective of the health care service provider were incorporated in the cost analysis (in 2009 USD) using a bottom-up approach. Tumour-specific treatments of surgery, chemotherapy and radiotherapy data in the initial year of disease were identified from the 401 CRN adult patients by a review of their medical records. Service utilization for diagnosis, staging, pre-operative assessment and post-operative follow-up consultations was estimated from the recommendations of established surveillance and clinical practice guidelines.Direct medical cost for the care of a newly diagnosed CRN was ranging from $1941 for low-risk polyp to $45 115 for stage IV colorectal cancer in the initial year of care. Costs of care showed a gradient increase from $1748 for low-risk colonic polyps to $42 899 for stage IV colon cancer, and from $2232 for low-risk rectal polyps to $48 453 for stage IV rectal cancers. Diagnostic/pre-operative assessment and treatment accounted for most of total costs of colorectal polyp (58.9–76.7%) and cancer (60.8–85.2%) care.The results provided stage and site-specific estimations of the direct medical costs of CRN in a Chinese population that can assist policy decision making and facilitate health care service planning and cost-effectiveness evaluations.