Optimizing Colorectal Cancer Screening in the Czech Republic: Cost-Effectiveness of Lowering the Starting Age to 45 and Introducing an Upper Limit
Author(s)
Ondrej Ngo, Ph.D.1, Katerina Hejcmanová, MSc1, Stepan Suchanek, Associate Professor2, Renata Chloupková, MSc1, Ladislav Dušek, Professor1, Miroslav Zavoral, Professor2, Bohumil Seifert, Associate Professor3, Karel Hejduk, PhDr.1, Ondrej Majek, Ph.D.1.
1National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic, 2Military University Hospital, Charles University, Prague, Czech Republic, 3Institute of General Practice, Charles University, Prague, Czech Republic.
1National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic, 2Military University Hospital, Charles University, Prague, Czech Republic, 3Institute of General Practice, Charles University, Prague, Czech Republic.
OBJECTIVES: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the Czech Republic. A properly implemented CRC screening programme can reduce disease burden and potentially lead to cost savings by avoiding the high costs associated with advanced-stage cancer treatment. The objective of our study was to evaluate the cost-effectiveness of various CRC screening strategies in the Czech Republic, with a particular focus on lowering the starting age to 45 years and introducing an upper age limit.
METHODS: The analysis used individual-level national data from the Czech National Registry of Reimbursed Health Services and the Czech National Cancer Registry. CRC treatment costs were estimated by analysing healthcare expenditures for cases (stratified by disease stage and clinical phase) and controls. Lifetime costs were estimated and incorporated into the cost-effectiveness framework alongside a modelled natural disease history and the screening process. A Markov model was developed from the healthcare payer perspective to compare screening strategies against a no-screening scenario, with a focus on starting at age 45 and setting an upper age limit of 74 years.
RESULTS: At a baseline participation rate of 45%, all CRC screening strategies were cost-effective compared to no screening, with increased screening costs offset by reductions in treatment expenses. Offering biennial FIT screening to individuals aged 50-74 and 45-74 years reduced average costs per person by over 75 EUR and 85 EUR, respectively. The corresponding life-years gained per person were approximately 0.05 and 0.06. Among the compared strategies, initiating screening at age 45 was the most cost-effective and cost-saving option, providing meaningful health benefits while remaining economically sustainable.
CONCLUSIONS: CRC screening in the Czech Republic is cost-effective. The findings support lowering the starting age to 45 years and upper limit 74 years, aligning with international trends and providing adjustments to national screening policies.
METHODS: The analysis used individual-level national data from the Czech National Registry of Reimbursed Health Services and the Czech National Cancer Registry. CRC treatment costs were estimated by analysing healthcare expenditures for cases (stratified by disease stage and clinical phase) and controls. Lifetime costs were estimated and incorporated into the cost-effectiveness framework alongside a modelled natural disease history and the screening process. A Markov model was developed from the healthcare payer perspective to compare screening strategies against a no-screening scenario, with a focus on starting at age 45 and setting an upper age limit of 74 years.
RESULTS: At a baseline participation rate of 45%, all CRC screening strategies were cost-effective compared to no screening, with increased screening costs offset by reductions in treatment expenses. Offering biennial FIT screening to individuals aged 50-74 and 45-74 years reduced average costs per person by over 75 EUR and 85 EUR, respectively. The corresponding life-years gained per person were approximately 0.05 and 0.06. Among the compared strategies, initiating screening at age 45 was the most cost-effective and cost-saving option, providing meaningful health benefits while remaining economically sustainable.
CONCLUSIONS: CRC screening in the Czech Republic is cost-effective. The findings support lowering the starting age to 45 years and upper limit 74 years, aligning with international trends and providing adjustments to national screening policies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE600
Topic
Economic Evaluation
Disease
Oncology