This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
The Cost-Effectiveness of Organized National Colorectal Cancer Screening Program in Croatia
by
, , , , and
August Cesarec
1
,
Nataša Antoljak
2,3,*,
Ivana Brkić Biloš
2,
Mario Šekerija
2,3,
Maja Vajagić
2 and
Neven Ljubičić
3,4,5 1
Faculty of Economics and Business, University of Zagreb, 10000 Zagreb, Croatia
2
Croatian Institute of Public Health, 10000 Zagreb, Croatia
3
School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
4
Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
5
School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(1), 150; https://doi.org/10.3390/cancers18010150
Submission received: 25 November 2025
/
Revised: 23 December 2025
/
Accepted: 30 December 2025
/
Published: 31 December 2025
(This article belongs to the Section Cancer Causes, Screening and Diagnosis)
Simple Summary
The organized National Colorectal Cancer Screening Program in Croatia was introduced by the government in 2007. Every two years, approximately 1,300,000 individuals aged 50–74 years are invited by mail to participate in guaiac fecal occult blood test (gFOBT) screening, and positive patients are referred for colonoscopy. Previous research has shown that colorectal cancer screening programs not only reduce disease-specific mortality but are also generally cost-effective. This study evaluates the costs of colorectal cancer screening in Croatia and compares the cost effectiveness of three screening strategies in the population aged 50 to 74 years: no screening, biennial gFOBT, and biennial fecal immunochemical testing (FIT). The results indicate that the introduction of FIT screening represents a cost-effective strategy for colorectal cancer screening in Croatia.
Abstract
Background/Objectives: Colorectal cancer is the most frequently diagnosed cancer and second by mortality among all cancers in Croatia. The Organized National Colorectal Cancer Screening Program was introduced by the government in 2007. It targets individuals aged 50–74 years with a biennial screening with a guaiac fecal occult blood test (gFOBT). The aim of this study is to analyze the costs associated with colorectal cancer in Croatia and to compare the cost-effectiveness of three screening strategies: no screening, biennial gFOBT, and biennial fecal immunochemical testing (FIT). Patients and methods: A model was developed to compare the three screening scenarios. The model simulated a cohort of 10,000 patients aged 50 years without colorectal cancer. Health outcomes and associated costs were projected over a five-year time horizon. The model outcomes include the number of newly diagnosed colorectal cancer cases, number of colorectal cancer-related deaths, life-years gained, and costs per life-year gained. Results: The average five-year costs per patient for the treatment of advanced cancer are EUR 39,802, which is substantially higher than the average costs of EUR 16,897 per patient across all stages. The implemented model indicates that both screening options yielded improved health outcomes at lower costs compared with no screening. FIT is considered the preferred screening option due to its higher sensitivity, greater health outcomes, and lower costs relative to gFOBT. Conclusions: The introduction of FIT screening instead of gFOBT could increase screening uptake for colorectal cancer, improve health outcomes, and reduce healthcare expenditures and the economic burden associated with colorectal cancer in Croatia.
