OBJECTIVES: To estimate the effectiveness and cost-effectiveness of colorectal cancer (CRC) screening among urban and rural residents from government perspective based on population in Pudong district, Shanghai, China.

METHODS: A Markov model was constructed to compare cost-effectiveness of screening strategy being executed in Pudong district in urban and rural residents. This strategy included twice fecal occult blood testing (FOBT) and necessary colonoscopy for 50-year-old population. We distributed 100,000 eligible samples to each Markov status at beginning of the model based on prevalence rate. The Markov length was 25 years with the transition probability collected from related researches (Markov cycle: one year). We estimated the cumulative quality-adjusted life-years (QALY) gained and cost to assess screening’s effectiveness and cost. The cost included screening publicity expense and medical expense collected from hospital information system in Pudong district. The cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER) represented by costs per QALYs gained. A one-way sensitive analysis was adopted to assess the stability and influence factors of the model.

RESULTS: Compared with no screening strategy, CRC screening brought 1874.49 QALY for urban residents and 5735.22 QALY for rural residents. These extra QALY caused CNY 2.77 million and CNY 2.64 million in urban and rural. The ICER was 1480.13 CNY/QALY for urban residents and 459.47 CNY/QALY for rural residents. Sensitive analysis shows when the screening compliance of urban resident increased to 60% from 20.3%, the ICER would dropped to 605.43 CNY/QALY. Results also reflected if screening compliance had linear relation with screening publicity expense, when the cost increased to 49.28 per person from 18.19 per person in urban, the ICER would dropped to 1258.33 CNY/QALY.

CONCLUSIONS: CRC screening has better effectiveness and cost-effectiveness in rural resident than urban resident for higher compliance. More publicity expense is required for urban residents.