The Cost-Effectiveness of Organized National Colorectal Cancer Screening Program in Croatia

Background/Objectives Colorectal cancer is a most common cancer by incidence and second by mortality among all cancers in Croatia. Organized National Colorectal Cancer Screening Program was adopted by government in 2007 and targets population aged 50-74 years. Every 2 years about 1,300,000 people are invited by letter to screening using gFOBT sent by preventive medicine team from county public health institutes. Citizens with a positive FOBT result are notified by telephone and referred for colonoscopy via the screening registry's electronic ordering system. They also receive instructions on how to prepare for the examination, and instructions by mail afterwards. Their family doctor is informed about this by letter and asked for their support if additional preparations of their patients are needed so that a polypectomy can be performed in the same procedure, if necessary. Previous studies have shown that, in addition to reducing mortality from colorectal cancer, money is saved by reducing the need for treatment advanced cancer or cancer in general. There is evidence that screening with fecal immunochemical test (FIT) achieves higher participation rates and much colorectal cancer patients detected. Given that the participation rate in Croatia is lower than desired, the aim of this study was to analyze the costs of colorectal cancer treatment and screening and compare three screening scenarios in terms of cost-effectiveness: no screening, biennial gFOBT test for people aged 50 to 74 years, and biennial FIT for people aged 50 to 74 years. Patients and methods: To compare the three scenarios, we developed a model based on the projection of 10,000 patients without colorectal cancer at age 50 and their health outcomes with associated costs over the next five years. The projected outcomes over the five years included treatment costs, number of new colorectal cancer patients, number of colorectal cancer deaths, life-years gained and costs per life-year gained. Results: Costs per patient five years after diagnosis for cost of advanced cancer treatment are 39,802€ and are significantly higher than costs of 16,732€ for non-advanced cases. The implemented model shows that screening options for colorectal cancer provide better health outcomes at lower costs compared to no screening. FIT is considered the preferred screening option due to its better sensitivity and better health outcomes and lower costs compared to gFOBT. Conclusions: Since the introduction of FIT screening instead of gFOBT could increase the proportion of people screened with the screening test, it would improve health outcomes and reduce health costs and the economic burden associated with colorectal cancer in Croatia.