Cost-Utility Analysis of Colorectal Cancer Screening Starting at Age 45 Compared to Age 50 in Colombia

Background: Colorectal cancer (CRC) is among the four cancers with the highest incidence and mortality in Colombia. CRC screening is currently recommended in national guidelines starting at age 50. The American Cancer Society has suggested beginning screening at age 45. Objectives: To estimate the cost-utility ratio of initiating CRC screening at age 45 compared to age 50 in Colombia. Methods: A Markov model simulating the natural history of CRC was used to compare the initiation of screening at ages 45 and 50. The cost-utility analysis incorporated costs and utilized Colombia’s per capita gross domestic product (GDP) threshold (COP 21,500,000). Results: Starting colonoscopy screening at age 45 was 0.33% less costly, yielded a gain of 3.49 quality-adjusted life years (QALYs), and reduced mortality by 37% compared to initiating at age 50 (costs: COP 92,364,407 vs. COP 92,669,231; QALYs: 19.40 vs. 15.91; and mortality proportion: 3.4% vs. 5.4%, respectively). Conclusion: Based on the Markov model analysis and the assumptions made, initiating CRC screening at age 45 was cost-effective. Costs were lower, more QALYs were gained, and the incremental cost-effectiveness ratio was below Colombia’s GDP threshold. A budget impact analysis is recommended to support the implementation of policies in Colombia.