The efficacy of population-based screening for colorectal cancer (CRC) with faecal occult blood test (FOBT) in terms of mortality reduction has been demonstrated in several randomized controlled trials. There are emerging novel methods for the CRC screening, incuding sigmoidscopy, colonoscopy, stool DNA testing , tomographic colonography, etc. Cost-effectiveness analyses on these methods have also been studied. However, for an area with low and intermediate incidence of CRC like Taiwan and other Asian countries, population-based screening may be rendered due to economic consideration and clinical capacity. Taiwan is one of Asian countries that have considered the implementation of population-based screening for CRC with feacal immunochemical test (FIT) since 1990s. The screening program for CRC have evolved with time in Taiwan. We aim to demonstrate the cost-effectiveness analysis for FIT based on the empirical experience of population-based screening in Taiwan.
　　We simulated a cohort with population’s characteristics and parameters relevant to CRC screening mimicked from the Keelung community-based integrated screening (KCIS) program. We estimated the disease natural history of colorectal cancer based on the community screening cohort. A probabilistic Markov decision model was adopted to evaluate the screening strategies of annual guaic-based FOBT (gFOBT) and feacl immuniochemical test (FIT) with 1-, 2-, and 3-year of interscreening intervals. Compared with no screening, all strategies were cost-saving.
　　Finally, the relationship of baseline fecal hemoglobin concentration to incidence of CRC and how such a relationship can be used for developing individually-tailored screening policy for CRC from the economic point of view will be discussed.