Impact of colorectal cancer screening programme on survival and employment in Taiwan: A nationwide analysis of real-world data

Background: Colorectal cancer (CRC) leads to life loss and a significant economic burden, which could be reduced by CRC screening. Objective: We assessed the potential savings of lives and employment to evaluate the effectiveness of the Taiwan CRC Screening Programme. Methods: Through interlinkages among Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim data, we enroled patients with colorectal adenocarcinoma, aged 50–74 years and diagnosed during 2004–2017, and followed them up to 2018. Life expectancy (LE), lifetime employment duration (LED), loss-of-LE and loss-of-LED were calculated, compared with age-, sex- and calendar year-matched cohorts. Assuming no difference within a specific stage for screen-detected versus non-screen detected CRC and weighting them by different stage distributions, we compared the total loss-of-LE and loss-of-LED. Results: The cohort enroled 77,169 patients with colorectal adenocarcinoma, which included 31,728 women (mean [SD] age, 62.5 [7.1] years) and 45,441 men (mean [SD] age, 62.8 [6.8] years). The mean loss-of-LE and loss-of-LED in women were 6.0 (95% confidence interval [CI] 5.7–6.3) and 1.0 (95% CI 0.8–1.1) year(s), whereas those in men were 5.1 (95% CI 4.9–5.4) and 1.1 (95% CI 1.0–1.2) years, respectively. Among the cohort, 53,678 cases had the screening information. On average, screening potentially saved 2.9 (95% CI 2.6–3.2) years of life expectancy plus 0.5 (95% CI 0.4–0.6) years of employment per case in women and 2.7 (95% CI 2.5–3.0) years plus 0.6 (95% CI 0.5–0.7) years in men, respectively. Conclusion: The Taiwan CRC Screening Programme is associated with the savings of lives and employment duration. Future studies are warranted to evaluate the cost-effectiveness of beginning screening at a younger age after accounting for saving employment loss and possibly adjusting lead time bias.