OBJECTIVES: Colorectal cancer (CRC) is one of the most frequently diagnosed cancers in Italy. According to the most recent estimates in Italy approximately 52,000 new cases are diagnosed and over 20,000 deaths occurred in 2014. A large number of patients are no longer surgically operable at the time of diagnosis and the generic symptomatology is often cause of a late diagnosis. The aim of this study was to determine the impact of colorectal screening programs implemented in Italy and by each Regional Healthcare Service in terms of mortality reduction and costs associated with the screening tests and surgery compared to drug therapy. METHODS: We identified the current colorectal screening programs adopted in each Italian region, mainly addressed to the age group 50-69 years. We compared incidence, mortality and prevalence data about CRC with target population’s adherence to the programs, detection rate and cancer stage. We used early indicators of impact established by GISCoR for program evaluation of colorectal cancer screening. Then we defined and analyzed the costs associated with the screening programs and surgery and we compared them with costs of drug therapy.  RESULTS: The spread of screening programs throughout Italy presents an upward trend with a significant increase in the North and Center of the country where regions  show higher rates of adherence (>45%). With regard to the proportion of tumors in stage <II the more effective is the Piedmont region. Regions with a greater reduction in mortality are Marche, Liguria, Tuscany and Emilia Romagna. Cost of care varies according to the care pathway: initial phase, continuing phase or  final phase. CONCLUSIONS: The study encourage the use of such analysis in a public health perspective, to increase understanding of patient outcomes and economic consequences of differences in policies related to cancer screening, treatment, and programs of care.