Analysis of colorectal cancer screening regimens.

We analyze several colorectal cancer screening methods. We begin with an existing deterministic model of the colorectal cancer growth-and-development model. Using judgments from two knowledgeable experts on colorectal cancer, we incorporate probability distributions for important parameters in the model. The analysis proceeds in three phases: First is a straightforward Monte Carlo simulation that includes uncertainty about structural parameters, the results of which identify five dominant screening strategies in terms of the expected number of cancers prevented and expected cost per life-year saved. The next part of the analysis develops a two-attribute utility function to rank order the screening regimens. The results show the same top five, with the top-ranked strategy being colonoscopy every three years. Sensitivity analysis demonstrates the robustness of the results.