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This study evaluates the cost\u2010effectiveness of earlier initiation and identifies the optimal screening strategy. A Markov model was developed to compare 48 screening strategies, combining different starting ages, methods (fecal immunochemical test [FIT], multitarget stool DNA [MT\u2010sDNA] test, methylated Septin 9 [\n                    <jats:italic>mSEPT9<\/jats:italic>\n                    ] test, computed tomography colonography [CTC], or colonoscopy), and frequencies, from the healthcare system perspective. Incremental cost\u2010effectiveness ratios (ICERs) were calculated based on quality\u2010adjusted life\u2010years (QALYs), with willingness\u2010to\u2010pay thresholds set at one\u2010 and three\u2010time China's per\u2010capita gross domestic product (GDP). The results show that all screening strategies are cost\u2010effective compared with non\u2010screening under the three\u2010time GDP threshold, with nearly half found to be cost\u2010saving. Starting annual FIT screening at age 40 is the most cost\u2010effective under both thresholds, with an ICER of US$5381\/QALY and reductions of 5.5% in CRC cases and 7.4% in CRC\u2010related deaths compared with the second\u2010best strategy of starting at age 45. Starting 10\u2010yearly colonoscopy screening at age 40 may be optimal, but only under very low thresholds. Both MT\u2010sDNA and\n                    <jats:italic>mSEPT9<\/jats:italic>\n                    tests would become the optimal options only if their costs were substantially reduced. The findings are highly robust across sensitivity analyses. This study supports the updated recommendation to lower the CRC screening initiation age for average\u2010risk individuals and identifies annual FIT screening as the optimal strategy in the current context of China.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70563","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:24:45Z","timestamp":1779769485000},"page":"1937-1948","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Effectiveness of Initiating Colorectal Cancer Screening at Age 40 Among Average\u2010Risk Individuals in China"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3773-6703","authenticated-orcid":false,"given":"Yuxuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics School of Public Health, Xi'an Jiaotong University Health Science Center  Xi'an 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