Patient preference and cost-effectiveness analysis of colorectal cancer screening and treatment

Abstract

Background/Aims: Colorectal cancer (CRC) screening and treatment have been reported to be cost-effective in many high-income countries. However, there was no such study in low- and middle-income countries (LMICs). This study aimed to assess the factors determine individuals’ preferences and cost-effectiveness of CRC screening and treatment.

Methods: This study consists of three parts. The first part focused on the factors determine individuals’ preferences for CRC screening using discrete choice experiment and multinomial logit model. The second part investigated the cost-effectiveness and budget impact analyses of CRC screening comparing between annual fecal immunochemical test (FIT) and colonoscopy every 10 years. The results from the first part can be used to improve patients’ participation rate which is the key factor for the cost-effectiveness analysis of the screening tests. Finally, the last part evaluated the cost-effectiveness and budget impact analyses of CRC stage III treatment. This part aimed to identify the most cost-effective treatment regimen in Thailand. The input parameters were obtained from Siriraj CRC screening and treatment projects, health care costs and databases of Thailand, and systematic literature review.

Results: A total of 400 respondents preferred screening with high risk reduction of CRC-related mortality, no complication, 5-year interval, less bowel preparation, and lower cost. FIT is the preferred choice of screening with the highest willingness-to-pay and uptake rate. From cost-effectiveness analysis results, both FIT and colonoscopy were cost-effective when compared to no screening. Colonoscopy was cost-effective when compared to FIT. However, colonoscopy required 8-times higher budget and more human resource than FIT. In addition, for CRC stage III, the new regimens of capecitabine and irinotecan will be cost-effective if the prices were reduced about 50-80%. The budget impact of early screening was lower than treatment due to the preventing of premature deaths.

Conclusions: This study provides real-world patients’ preference and cost-effectiveness evidence of CRC screening and treatment. Annual FIT was preferred to other screening tests and it could be implemented with no human resource and financial constraint. The new drugs for CRC stage III treatment were not cost-effective. Policy makers can use these findings to improve the success rate of CRC screening and appropriate treatment in Thailand.