COST-EFFECTIVENESS OF COLORECTAL CANCER SCREENING STRATEGIES IN LOW- AND MIDDLE-INCOME COUNTRIES: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Author(s)
Issaraphorn Khaomeesri, Medical student1, Jetnipat Jirajitkarun, MD1, Luxzup Wattanasukchai, MSc, MD2.
1Faculty of medicine, Khon Kaen university, Khon Kaen, Thailand, 2Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen university, Khon Kaen, Thailand.
1Faculty of medicine, Khon Kaen university, Khon Kaen, Thailand, 2Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen university, Khon Kaen, Thailand.
OBJECTIVES: Colorectal cancer (CRC) is a leading cause of global cancer mortality, with increasing incidence in low- and middle-income countries (LMICs). While screening effectively reduces CRC burden, and the economic evidence is well-established in high-income countries, limited economic evaluations from LMICs hinder evidence-based policymaking. This study aims to synthesize economic evidence on CRC screening strategies for average-risk populations in LMICs.
METHODS: PubMed, Embase, Scopus, Tufts CEA, and iHTA databases were systematically searched from inception to May 31, 2024. Full economic evaluation of average-risk individuals aged ≥45 years were included. Studies on metastatic cancer and non-human studies were excluded. All costs were converted to 2024 US dollar purchasing power parity ($PPP). A meta-analysis using a random-effects model estimated pooled incremental net benefits (INBs). Heterogeneity was assessed using I2 statistics with subgroup analyses performed. Publication bias was evaluated using funnel plot, and study quality was assessed using ECOBIAS checklist.
RESULTS: Seventeen studies published between 2008 and 2022 were included: fifteen from upper-middle-income and two from lower-middle-income countries. None were conducted in low-income countries. All studies found CRC screening more cost-effective than no screening. Meta-analysis of annual Faecal Immunochemical Testing (FIT) versus no screening in middle-income countries demonstrated that annual FIT is cost-effective intervention, yielding pooled INB of $PPP2,365.89 (95% CI: 223.95 to 4,507.82). However, heterogeneity was substantial (I2= 97.99%), and asymmetrical funnel plots suggested potential publication bias. Exploration of heterogeneity suggested that small-sample studies contributed importantly to the observed variability.
CONCLUSIONS: Interest in CRC screening in LMICs has increased alongside rising incidence. However, a critical lack of evidence persists for low-income countries. Meta-analysis indicates that annual FIT is cost-effective in middle-income countries. Further economic evaluations in low-income settings and research reporting all key deviations are essential to inform resource allocation and guide evidence-based screening policies. (PROSPERO register: CRD420251116348)
METHODS: PubMed, Embase, Scopus, Tufts CEA, and iHTA databases were systematically searched from inception to May 31, 2024. Full economic evaluation of average-risk individuals aged ≥45 years were included. Studies on metastatic cancer and non-human studies were excluded. All costs were converted to 2024 US dollar purchasing power parity ($PPP). A meta-analysis using a random-effects model estimated pooled incremental net benefits (INBs). Heterogeneity was assessed using I2 statistics with subgroup analyses performed. Publication bias was evaluated using funnel plot, and study quality was assessed using ECOBIAS checklist.
RESULTS: Seventeen studies published between 2008 and 2022 were included: fifteen from upper-middle-income and two from lower-middle-income countries. None were conducted in low-income countries. All studies found CRC screening more cost-effective than no screening. Meta-analysis of annual Faecal Immunochemical Testing (FIT) versus no screening in middle-income countries demonstrated that annual FIT is cost-effective intervention, yielding pooled INB of $PPP2,365.89 (95% CI: 223.95 to 4,507.82). However, heterogeneity was substantial (I2= 97.99%), and asymmetrical funnel plots suggested potential publication bias. Exploration of heterogeneity suggested that small-sample studies contributed importantly to the observed variability.
CONCLUSIONS: Interest in CRC screening in LMICs has increased alongside rising incidence. However, a critical lack of evidence persists for low-income countries. Meta-analysis indicates that annual FIT is cost-effective in middle-income countries. Further economic evaluations in low-income settings and research reporting all key deviations are essential to inform resource allocation and guide evidence-based screening policies. (PROSPERO register: CRD420251116348)
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE94
Topic
Economic Evaluation
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology, STA: Surgery