A comprehensive and multifaceted analysis of colorectal cancer screening in Iran

Principle investigator: Reza Rezayatmand[*],

Co-investigators: Elham Tabesh, Mohsen Rezaei Hemami, Farimah Rahimi, Zahra Ravankhah and Silvia Evers.

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in United State and it’s the third and second most commonly diagnosed cancer among Iranian men and women, respectively. Thus, the economic burden of the disease is quite substantial. However, many of those premature deaths can be avoided by a timely diagnosis of the cancer. Consequently, the economic burden will be significantly reduced. Thus, CRC screening program is being defined in many countries, particularly in developed countries where the incidence and prevalence is high.

In Iran, Isfahan province has been piloted for Irapen program. The program aims to reduce mortality and morbidity due to non-communicable disease by the early detection of disease in those who involved. After three years of starting the program, the cost-effectiveness of CRC screening among the general population has been questioned.  Many of those with positive FIT have not followed the colonoscopy recommendation. Although if they wanted to follow, there was not enough facility to meet their needs. Given those facts, it seems necessary to systematically analyze the program to see to what extent it has worked so far, and it will work for the whole country in the future, taking into account the specific context of Iran. Thus, this project seeks to introduce comprehensive evidence-based national screening guideline to Iran health care system. In addition to developing a guideline for CRC screening, the project will consider a step by step approach for guideline implementation. So the project is designed in three phases i.e. descriptive phase, context analysis, and guideline development and approval. Each phase includes several small projects. According to a specific research question addressed by each project, appropriate quantitative, or qualitative or mixed research strategy will be used. These range from systematic review and meta-analysis to econometric modeling, economic evaluation and discrete choice experiment.

[*] Assistant Professor in Health Economics, Health Management & Economics Research Center, Isfahan University of Medical Science. Email: reza.rezayatmand@gmail.com