Background <p>Colorectal cancer (CRC) screening reduces cancer-specific mortality and is widely recommended by international agencies. The fecal immunochemical test (FIT) is the preferred strategy for population-based screening. Although FIT-based screening is considered cost-effective internationally, no local evidence is available, and implementing such a program may require substantial resources. This study evaluated the cost-effectiveness and budget impact (BI) of introducing a FIT-based CRC screening program for the insured population of the Fundación Arturo López Pérez (FALP) Cancer Center.</p> Methods <p>A Markov model was developed to assess the cost-effectiveness of the FIT screening program compared with no screening. Healthy beneficiaries aged 50–69 years were invited to undergo FIT every two years. Expected costs, life-years gained (LYG), and the incremental cost-effectiveness ratio (ICER) were estimated, along with the BI. Deterministic sensitivity analyses were performed, and co-payment scenarios involving out-of-pocket expenses were also explored.</p> Results <p>The FIT-based CRC screening program was cost-effective across all scenarios analyzed, and even in a co-payment scenario it was dominant over no screening. FIT adherence and FIT positivity rate had the greatest influence on cost-effectiveness outcomes. Although the ICER indicated a favorable cost-effectiveness profile, BI estimates for the base-case scenario highlighted the substantial financial burden of implementing the program. Co-payment scenarios markedly reduced BI, making the program more affordable.</p> Conclusions <p>FIT-based CRC screening is a cost-effective strategy for the FALP-insured population. However, its significant budgetary impact may hinder implementation. Shared funding mechanisms could mitigate these financial barriers and enhance program feasibility.</p>