Abstract

Objectives

The purpose of this study is to evaluate the cost-effectiveness of increasing access to colorectal cancer (CRC) diagnosis, considering resource limitations in Thailand.

Methods

We analyzed the cost-effectiveness of increasing access to fecal immunochemical test screening (strategy I), symptom evaluation (strategy II), and their combination through healthcare and societal perspectives using Colo-Sim, a simulation model of CRC care. We extended our analysis by adding a risk-stratification score (RS) to the strategies. We analyzed all strategies under the currently limited annual colonoscopy capacity and sufficient capacity. We estimated quality-adjusted life-years (QALYs) and costs over 2023 to 2047 and performed sensitivity analyses.

Results

Annual costs for CRC care will increase over 25 years in Thailand, resulting in a cumulative cost of 323B Thai baht (THB). Each strategy results in higher QALYs gained and additional costs. With the current colonoscopy capacity and willingness-to-pay threshold of 160 000 THB, strategy I with and without RS is not cost-effective. Strategy II + RS is the most cost-effective, resulting in 0.68 million QALYs gained with additional costs of 66B THB. Under sufficient colonoscopy capacity, all strategies are deemed cost-effective, with the combined approach (strategy I + II + RS) being the most favorable, achieving the highest QALYs (1.55 million) at an additional cost of 131 billion THB. This strategy also maintains the highest probability of being cost-effective at any willingness-to-pay threshold above 96 000 THB.

Conclusions

In Thailand, fecal immunochemical test screening, symptom evaluation, and RS use can achieve the highest QALYs; however, boosting colonoscopy capacity is essential for cost-effectiveness.