Cost-Effectiveness of Colorectal Cancer Screening in the Dominican Republic

Colorectal cancer (CRC) incidence is increasing worldwide, particularly in middle-income Caribbean countries like the Dominican Republic (DR), where CRC is now the third-most prevalent cancer. Despite this trend, no national or regional CRC screening guidelines exist across the Caribbean region, and screening is not routinely performed in the DR. In this study, we evaluated the cost-effectiveness of four CRC screening strategies versus no screening.

We developed a Markov model of CRC to compare no screening (natural history, NH) to four screening strategies: colonoscopy every ten years (Colo), sigmoidoscopy every five years (Sig), biennial fecal immunohistochemical test (FIT), and biennial fecal occult blood test (FOBT), from age 45 to 75. Model inputs were derived from international trials, GLOBOCAN, SEER, and local data. We assumed 60.6% adherence to screening for all strategies. The primary outcome was the incremental cost-effectiveness ratio (ICER) per disability adjusted life year (DALY) averted. Secondary outcomes included CRC incidence, mortality, and number of lifetime colonoscopies.

In the NH strategy, 2.3% developed and 1.0% died from CRC, with a lifetime cost of $73.89 per person. FIT reduced CRC incidence by 30% and death by 37%, with a lifetime cost of $101.39 and ICER of $2,134.75 per DALY averted. Colo was more effective, reducing CRC incidence by 50% and death by 52%, but exceeded the willingness-to-pay threshold (ICER: $12,903.51). FIT required 371 lifetime colonoscopies per 1,000 people vs. 1,953 for Colo. Results were most sensitive to screening test performance and test costs.

Biennial FIT is a cost-effective CRC screening option for the DR, averting a significant number of CRC cases and deaths at low incremental cost. Inclusion of local data on effectiveness and acceptability of CRC screening modalities would strengthen results. These findings can inform development of CRC screening guidelines in the DR and the wider Caribbean region.