Cost effectiveness analysis of colorectal cancer screening modalities in Kuwait: Comparison of Three Alternative Screening Strategies

Abstract Colorectal cancer (CRC) poses a significant health challenge in Kuwait, ranking as the second most common cancer with a 2019 incidence rate of 13.2 cases per 100,000 people. This study evaluates the cost-effectiveness (CEA) of CRC screening methods from the perspective of Kuwait's healthcare providers. Using a Decision Tree Analysis Model, the study compared three screening modalities: Fecal Occult Blood Test (FOBT) followed by colonoscopy or sigmoidoscopy, colonoscopy alone, sigmoidoscopy alone and alongside no screening. Over a 10-year period post-diagnosis, the model tracked costs and outcomes based on CRC patients' life expectancy, expressing results using Incremental Cost Effectiveness Ratios (ICERs). Result: FOBT followed by colonoscopy or sigmoidoscopy emerged as the most cost-effective option, costing USD 3,573.00 and yielding 7.7 Quality-Adjusted Life Years (QALYs). In comparison, no screening resulted in 7.2 QALYs at USD 4,084.00, while sigmoidoscopy and colonoscopy alone provided 6.8 QALYs each, costing USD 4,905.00 and USD 5,002.00, respectively. Sensitivity analyses explored uncertainties in cost and outcome estimates. Conclusion: FOBT followed by colonoscopy or sigmoidoscopy could efficiently utilize healthcare resources compared to other modalities or no screening. This approach offers critical guidance for healthcare policymakers in Kuwait, advocating for the adoption of combined FOBT and colonoscopy or sigmoidoscopy strategies to enhance CRC screening effectiveness and economic efficiency.