Cost-Effectiveness Analysis of Colorectal Cancer Screening Strategies

Colorectal cancer screening is widely recognised as a vital public health intervention capable of reducing incidence and mortality through early detection of precancerous lesions. Cost-effectiveness analysis (CEA) applies economic evaluation methods to compare the lifetime costs and health outcomes of different screening strategies, typically expressed in terms of cost per quality-adjusted life-year (QALY) gained or incremental cost-effectiveness ratio (ICER). Common modalities include faecal immunochemical testing (FIT), guaiac faecal occult blood testing, flexible sigmoidoscopy, computed tomographic colonography and colonoscopy at varying intervals. Analyses frequently employ Markov or microsimulation models to represent the natural history of adenoma progression, screening adherence, test performance and downstream treatment costs. Such models inform resource allocation by incorporating regional variations in healthcare infrastructure, reimbursement rates and patient demographics. Global studies highlight that comparatively low-cost, non-invasive tests often dominate in average-risk populations, while colonoscopy strategies may prove preferable in settings with sufficient endoscopic capacity and higher disease prevalence. Open-source modelling frameworks and improved transparency in model assumptions have recently enhanced reproducibility and policy relevance, guiding decisions on optimal screening age ranges, intervals and follow-up protocols in diverse health-care systems.

Research from Nature Portfolio

Recent studies have compared the real-world cost-effectiveness of FIT and colonoscopy using observational data from community screening services. A seminal analysis evaluated over 10,000 participants followed for five years, showing that colonoscopy detected substantially more adenomas and advanced lesions than FIT but incurred higher procedural costs. Incremental cost-effectiveness ratios varied by lesion type and risk subgroup, with colonoscopy deemed cost-effective for detecting advanced neoplasia and early-stage cancer when compared to FIT as the control. This work remains influential in understanding trade-offs between test sensitivity, compliance and health-system expenditure.

Cost-Effectiveness Analysis of Colorectal Cancer Screening Strategies publication trend

The graph below shows the total number of articles in cost-effectiveness analysis of colorectal cancer screening strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Cost-effectiveness analysis (CEA): An economic evaluation comparing costs and health outcomes of competing interventions, often expressed in cost per QALY gained.

Incremental cost-effectiveness ratio (ICER): The additional cost divided by the additional health gain when comparing two strategies.

Quality-adjusted life-year (QALY): A composite measure reflecting both the quantity and quality of life lived, used to assess the value of medical interventions.

Markov model: A mathematical framework that simulates transitions between health states over time, capturing disease progression, screening and treatment events.

References

1. A Comparison of International Modeling Methods for Evaluating Health Economics of Colorectal Cancer Screening: A Systematic Review. Value in Health (2025).
2. CMOST: an open-source framework for the microsimulation of colorectal cancer screening strategies. BMC Medical Informatics and Decision Making (2017).
3. Cost-effectiveness analysis of colonoscopy and fecal immunochemical testing for colorectal cancer screening in China. Frontiers in Public Health (2022).
4. The comparative cost-effectiveness of colorectal cancer screening using faecal immunochemical test vs. colonoscopy. Scientific Reports (2015).