Cost effectiveness analysis of three colorectal cancer screening modalities in Kuwait

Colorectal cancer (CRC) poses a significant health challenge in Kuwait, ranking as the second most common cancer with the incidence rate 13.2 cases per 100,000 people in year 2019. This study aims to determine the cost-effectiveness of three colorectal cancer (CRC) screening methods in Kuwait 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). Colorectal cancer screening using FOBT followed by colonoscopy or sigmoidoscopy resulted in 7.7 quality-adjusted life years (QALYs) at a cost of USD 3,573. In contrast, no screening achieved 7.2 QALYs but was more expensive, costing USD 4,084. Screening with only sigmoidoscopy or only colonoscopy provided 6.8 QALYs each, at costs of USD 4,905 and USD 5,002, respectively. Sensitivity analyses explored uncertainties in cost and outcome estimates. FOBT followed by colonoscopy or sigmoidoscopy can be considered as an efficient and effective approach towards early detection of CRC. This approach can be used by healthcare policymakers in Kuwait, in the development of population-based CRC screening programs to optimize resource allocation and improve public health outcomes.