Decision Programming for optimizing the Finnish Colorectal Cancer Screening Program

TL;DR

This paper introduces a decision programming approach to optimize FIT cut-off levels in Finland's colorectal cancer screening, aiming to reduce cancer prevalence and costs under capacity constraints.

Contribution

It applies a novel decision programming method to determine optimal screening thresholds tailored to Finnish populations, considering capacity and cost constraints.

Findings

Optimal FIT cut-off levels for different population groups.

Estimated reduction in cancer prevalence.

Cost and colonoscopy requirements for strategies.

Abstract

In Finland colorectal cancer (CRC) incidence rates have steadily increased over the last decades and as of 2017, CRC is the sixth most common cause of death. CRC is a crucial concern for the public health of Finland. We optimize the faecal immunochemical test (FIT) cut-off level for specified target populations with regard to minimization of cancer prevalence with Decision Programming, which is a novel approach to solving discrete multi-stage decision problems under uncertainty. The results present optimal cut-off levels for Finnish target groups with different colonoscopy capacity constraints. Finally, the estimated resulting cancer prevalence, the amount of required colonoscopies and third-party payer costs resulting from found strategies to the newly implemented Finnish CRC Screening Programme, which have not previously been published, are presented.