OBJECTIVES:  Precautionary medical check-ups have proven to be an essential tool in colorectal cancer (CRC) prevention, which is due to the long, asymptomatic carcinogenesis of CRC. This research aims at evaluating the market-leading screening methods, the colonoscopy (COLO), the sigmoidoscopy (SIGM), the flexible occult blood test (FOBT) and the DNA-Test (DNA), and examining the effect of cancer-causing risk factor on the patient’s prognosis. METHODS:  A cost-effectiveness-analysis of the leading screening methods in the Austrian population in the 50+ age group was performed. Therefore an agent-based simulation model of the colorectal cancer prevention in Austria was developed. Natural development and progression of CRC including the influence of risk factors like smoking, drinking and gender were analysed to consider an indirect method of interference. Through scenario calculation and system analysis various parameter settings and possible situations were calculated as an instrument for future planning in the Austrian health care system. Besides the alternative options to the current national screening programme, also the possibility of an indirect preventive measure, the introduction of an organized invitation procedure and the adjustment of screening recommendations were examined. RESULTS:  COLO and SIGM turned out to be the most cost-effective methods followed by FOBT. The national screening program that consists of annual FOBT and COLO every 10 years proved to be the most efficient regarding CRC prevention and cost-effectiveness. An increase of the Austrian screening participation from 12% to 60% in the model lead to a CRC-incidence and -mortality reduction of 60%. CONCLUSIONS: Even though the model predicted the colonoscopy procedures as the most cost-effective alternatives, one must keep in mind the invasiveness of these examinations and the associated problems. The long-term target should be to increase the willingness of the general population to participate in pre-medical check-ups. DNA carries a burden of costs, which is currently unjustified.