Optimizing Colorectal Cancer Screening Strategies and Target Populations in Budget-Constrained Regions through Cost-Effectiveness Analysis: A Case from China's East

Abstract

Abstract Introduction: Colorectal cancer (CRC) is among the top three cancers globally in terms of morbidity and mortality. For middle-income countries planning to implement regional screening programs, conducting a preliminary assessment to identify individuals at a higher risk of CRC before proceeding with a colonoscopy can be more cost-effective. Methods: We employed a microsimulation model to assess the impact of various preliminary assessment strategies. Simulations were conducted to identify the optimal age for initiating and ending screening. Results: The primary data were sourced from the Huzhou screening program, which included 418,805 individuals from 2020 to 2022. All screening strategies were found to be effective, with the cost per incremental Quality-Adjusted Life Year (QALY) being less than $1,026, which is below the minimum standard for upper-middle-income countries. The most effective screening strategy was the annual combined two-sample Immunochemical Fecal Occult Blood Test (i-FOBT) and risk evaluation questionnaires. This approach led to a reduction in CRC incidence and related deaths by 2435 and 1174 cases per 100,000 individuals, respectively, and an increase in Life Years Saved (LYS) by 13903 years and QALYs by 35564 years. The recommended ages to begin and end screening were 48 and 72 years, respectively. Conclusions: All CRC screening strategies demonstrated effectiveness compared to non-screening, with the annual combined two-sample i-FOBT and risk evaluation questionnaires emerging as the optimal approach. For additional regions, the best screening strategy can be selected based on the health outcomes and costs we have provided.